CURRICULUM FOR PUPILS WITH PROFOUND AND MULTIPLE LEARNING DIFFICULTIES

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CURRICULUM FOR PUPILS WITH

PROFOUND AND MULTIPLE LEARNING

DIFFICULTIES

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3. The Principles of the PMLD Curriculum

6. Assessment

7. Examples of the Curriculum in Practice

8. Body Awareness

9. Communication

10. Health and Safety and The Resonance Board

11. Sherborne Movement

12. Health and Safety for Adults

14. Pupil Education Profile

16. Potential Learning Outcomes

17. Touch Profile

18. Overview of Activity Cards

23. ICT Fact Sheet

24. Peter – Touch Profile

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Introduction

In 2010 we at The Bridge School, decided to research the curriculum offer for pupils with PMLD in a large variety of schools. This research took the form of ordering curriculum documents for sale from other schools, and visiting a number of schools to find out what they were doing and why. This information was shared with and was discussed between a core group of staff concerned with the education of PMLD pupils. These discussions resulted in our first attempt at defining a Bridge PMLD curriculum. We have since revisited our earlier thinking and revised it, particularly following our experiences of implementing the curriculum for pupils with ambulant PMLD. This document provides an overview of our revised PMLD curriculum.

This curriculum overview recognises that children and young people with Profound and Multiple Learning Difficulties have unique abilities and ways of learning. Pupils who are described as PMLD are likely to remain within developmentally early intellectual parameters for the whole of their school lives and the curriculum needs to be approached in a different way than for those who have higher cognitive ability. Additionally many assessment models do not recognise all the progress and

development that we know that those with PMLD can make.

This curriculum overview gives ideas, not instructions. It is up to the individual pupils’ educators to decide what is or is not appropriate and write this into the learning plans for each individual. The child/ young person must be at the centre of the educational process. It is not the responsibility of the child to change to meet the demands of the curriculum; it is the responsibility of those providing the curriculum to ensure that it is flexible enough and adaptable enough to meet the needs of each child/ young person. Adults are the facilitators of the children and young person’s learning and it is key that all agencies (for example nursing, speech and language therapy, occupation therapy, physiotherapy) work together in an integrated way to maximise the learning opportunities.

At The Bridge we believe that how we are (as adults and essential facilitators in learning) directly affects how our pupils are and how well they learn. We must therefore all take individual responsibility for being and remaining positive with our learners at all times.

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THE PRINCIPLES OF THE PMLD CURRICULUM

There are five key principles to this curriculum

1. Students learn through interaction

2. All subjects happen at the same time 3. Teaching is led by the pupil

4. The pupil determines the activities

5. The curriculum promotes independence

1. Students learn through interaction

• Our curriculum is based on the understanding of what the individual pupil

needs. Comfort, security, stimulation and motivation have to be accounted for in any situation.

• Having a good relationship with staff members is paramount to the students’

learning experience. Through interaction pupils can learn to trust the adults and the adults can learn about the pupils’ abilities, interests and preferred communication approaches, their feelings and their discomfort.

• Once a relationship is established we can understand what the pupils’

interests are. If the students have not yet built up a repertoire of interests we can then find objects and activities of interest through the safe and secure ‘friendship’ that has developed through the interaction sessions. When these have been established, they can be used to motivate the student s to

communicate and develop independence.

• A pupil with PMLD will spend a large proportion of the day maintaining and

consolidating what has already learnt so as not to lose skills and

understanding. New concepts and skills will be taught, when appropriate, in the framework of a familiar and structured session or activity.

• Our Curriculum starting point is not the core areas or specific objectives but the social interaction of the students within the activities. Everything is happening at once, and the chances for students to learn are multiple

provided that some basic elements are present, i.e. the right communication approach, the repetition of the routines, motivation, comfort, an appropriate physical environment, enough time, etc.

2. All subjects happen at the same time

• The most basic curriculum structure consists of three main areas: Cognitive

development; Emotional, social and communicative development and Physical, Motor and Sensory development. The areas are interrelated and dependent of each other.

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• Our students’ curriculum is naturally an integrated curriculum that each

student accesses through the adult: there is communication involved in practically everything, they observe and explore (what others call Science), it can involve shapes and quantities (Maths), it tends to involve at least two people (Social and Emotional skills), etc.

• This curriculum does not provide the contents of the identified three main areas so that teachers are not constrained. These decisions are made with the students’ needs, motivation, etc. in mind.

• We do not consider that the traditional subject boundaries matter.

• These core strands will be supported through Activities. There is not a

definitive list of such Activities, and apart from Intensive Interaction, teachers are free to choose which activities they want to use. We wish to encourage innovation from all our staff.

2. Teaching led by the pupil

• Learning is taken as a whole rather than through teaching to specific

individualised targets. The student decides where the learning process will go; and therefor the student will decide pace and direction of teaching.

• Individual progression is often best recognised in retrospect, at the end of

each session, week, half-‐term, term and/or year. This retrospective target setting is legitimated by the tendency of objectives based teaching to narrow the learning opportunities.

• Recording and reporting on progress is absolutely vital and we strongly recommend that each teaching session looks for opportunities to celebrate success, record specific pupil progress, pick up areas of concern, and inform the next lesson. At this vital time, the teaching team reflects on what they have seen and heard, taking the lesson as a whole but more importantly, each individual learner one at a time.

• Skills Based Learning recognises that certain skills need to be acquired by much practice and this will also be used when appropriate.

3. The pupil determines the activities

• The teacher is the one setting up a social situation where the child and the

adult are together on a task. The adult decides what to do based on what the child can do and it is interested in. The teacher’s role is to provide routines, to enable the students to make decisions and to allow variation by them.

• Our aim is to put the students in control by giving them an environment that

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development. Once the students know how a simple routine works, they can introduce variations, and once they are doing that, they are in control. They develop the routine and it becomes more complex.

• We have to listen to the student’s requests and choices. Allowing requests helps to develop the student’s autonomy. When they state a preference and they get it, they are empowered. They decided, they tried to affect the world and were successful.

• Spontaneity comes out of the children knowing the structure of the routines

and when they are empowered.

• We have to create learning opportunities. The best way to do that is to

embed broad enough demands in easy enough language or ways of

communicating and easy enough routines to engage the students. Those are the principles, they don’t change, but how we translate them into practice will vary according to the students. Any technique that does not allow them freedom, any technique that does not give them a structure, any technique that does not create certain cognitive demands, any technique that creates too great cognitive demands, are not supportive of the pupil’s learning. We should aim to set up situations that are both challenging and enabling.

6. The curriculum promotes independence

• Within activities pupils may reach, hold, explore sensory items/stimuli and

use switches. It is imperative the students are able to explore the physical world as independently as possible (in terms of touch from an adult). This will lead to a clearer and more concrete understanding of the subject being explored. When physical support is required strategies such as hand-‐under-‐ hand and hand-‐under-‐ elbow ensure the student is not being dominated by adult touch and the student is still able to focus on the activity. (See touch profile)

• Supporting the students to be as independent as possible means different

things in different educational situations, for example personal care and manual handling includes changing, eating and drinking, travelling around the building/community and hoisting. These activities/routines occur every day and possibly many times a day. It is important to prompt the student before the activity happens and throughout each stage of the routine to enable them to process what is about to happen and give them the opportunity to help. For example ‘we are going to roll you onto your side’ -‐ including a touch prompt and then a count ‘1, 2, 3’. This gives the students the opportunity to help roll/move themselves. Mediation strategies can be added to each of these activities to help inform the students of the different stages involved.

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ASSESSMENT

Assessment, at regular intervals and in the most rigorous forms possible, is an absolute necessity if we are to be certain about providing an appropriate and

individualised curriculum to each learner. It is certainly not optional. Fortunately, we have at our disposal Routes for Learning (RfL) a copy of which is available from your head of site. Written by a number of Welsh (PMLD) teachers and academics under the guidance of Jean Ware and published in 2006 by the Welsh Qualification and Curriculum Group, RfL notes 43 possible milestones which learners may or may not pass through in their educational and developmental journey through life. These milestones are broadly divided into cognitive and communicative, though a number (naturally) meet in the middle. Of the 43, there are seven which are key, these being 1) Notices stimuli; 9) Responds consistently to one stimulus; 23) Contingency

responding; 26) Contingency awareness; 34) Object permanence; 36) Selects from two or more items; 43) Initiates actions to achieve desired result (exerting autonomy in variety of contexts). The numbers allocated indicate where they appear in the whole map.

A rigorous and accurate assessment procedure informs teaching, drives the recording of progress and is key to the successful education of our learners.

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EXAMPLES OF THE CURRICULUM IN PRACTICE

On the following pages examples are provided of the pupil profiles which set the learning intentions for individual pupils, touch profiles which explain in detail the support each student requires to access learning opportunities and activity cards which demonstrate activities with differentiation for each individual. These are provided to give a real life feel to our curriculum and show how it works in practice.

PUPIL EDUCATIONAL PROFILE Name: xxx

Date of Birth: xx/xx/xxxx Class: xxx

Language/s spoken at home: xxx Religion: xxxx

Physiotherapist: xxxx OT: xxxx

SLT: xxxxx

Pupil Educational Profile updated the xx of xx 2011

Routes for learning 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 14, 16, 17, 18, 19, 20, 21, 23 (example) (Only

numbers here of achieved outcomes).

Physical and Sensory

Where she/he is at the moment:

If the student has a physical impairment or condition, how is this affecting her/his physical day to day and Sensory development?

Sensory. Information about preferred and not preferred learning environment and sensory input. Also note any recent significant change in responses to sensory input. Physiotherapy and body Posture. Description of specialised equipment (standing frame, work chair, side layer, AFOs, etc.) that the student is using and what activities she/he takes part to develop motor skills, body posture and body positioning. We could note here how the student reacts to the equipment, stretches, etc. Potential learning outcomes:

Physiotherapists and OTs can assist you in this point if there is any specific objective.

Social and Emotional

Where she is at the moment:

Patterns of learning. Physical and vocal clues of communication (when motivated and when not). Preferred teaching style and grouping. Preferred style of interaction. Potential learning outcomes:

Process based and skills based learning. Refer to Routes for Learning and, if developing a particular communication system (skills based), the next steps of that system. We have to think laterally and horizontally when considering the potential learning outcomes.

Cognitive Development

Where she is at the moment:

From Routes from Learning. Preferred leisure activities. Also switch level if using switches.

Potential learning outcomes:

Process based and skills based learning. Refer to Routes for Learning and, if developing a particular system such as switch work (skills based), the next steps of that system.

Other information

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Communication

Potential Learning Outcomes

• Specific for A., C., J.:

- Awareness: demonstrating any kind of awareness of the sounds of the activity.

- Turn-taking: participating, in any way, in the turn-taking structure of the activity.

- Showing self: demonstrating a 'this is me' behaviour' to gain someone else's attention, by smiling, vocalising, eye-contact etc. - Seeking physical proximity: moving or turning towards another person to indicate intention to communicate.

• D.

- Turn-taking: participating, in any way, in the turn-taking structure of the activity.

- Anticipation: demonstrating anticipation of a word, phrase or sound effect.

-To show contingency awareness on the resonance board.

• E., L. and A.

- Gaze alternation: looking from person to person. - Turn-taking: participating, in any way, in the turn-taking structure of the activity.

-To show contingency awareness on resonance board. -Persevering by repeating actions

-Early problem solving.

Description:

Activity Description Focus

Hello -La la la la la la, hello, hello to everybody and then using individual names.

-Beginning

-Becoming alert, aware

-Gaining eye contact, attention.

Names - Tap tap ssh ssh tap tap X

- Name chants

- Various names at once

-Establish who is in the group -Recognition of name

-Responding to own name.

Shake hands

-Lift arms slowly while raising voice wait for looking/vocalising then down with a bang.

-Shake hands

-Swing up, Swing down

-Visual tracking of hands -Listening,

-Anticipating

-May indicate ‘more’ Stop, start,

listen

-Tapping and chanting quietly then getting louder. -slowly/quickly -getting faster -getting quiet -Listening, -Anticipating

-May indicate ‘more’

Hide and find

-Using fabric lift and lower. Tap to tune e.g. drunken sailor

-Someone is hiding

-Indicate up, down, more, again

Finishing -Goodbye chanting and tapping

gently -Finish

-Calming, relaxing -Anticipating ending

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Health and Safety and the Resonance Board

• Check the boards for splinters each time that they are used. • Wipe the boards after use with soapy water only.

• Place the boards so that there are no gaps in which fingers could be trapped. • Use non-lip matting underneath the boards if necessary.

• Provide PE mats or cushions around the board so that pupils and staff are comfortable.

• When lying pupils on the boards make sure that they are not looking directly into the light including natural light. • When lying pupils on the board make sure that they do not have their head or spine over a join.

• Keep heads and feet away from each other. Either heads in the middle, or feet in the middle.

• Ponytail bobbles and hair bands can be uncomfortable. They should be removed before the pupil lies on the board. • Be aware that sounds created on the board can be very loud and intimidating

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Sherborne Movement

Potential Learning Outcomes

• Specific for A., C., J.:

-‐ Awareness: demonstrating any kind of awareness of the sounds of the activity.

-‐ Turn-‐taking: participating, in any way, in the turn-‐taking structure of the activity.

-‐ Showing self: demonstrating a 'this is me' behaviour' to gain someone else's attention, by smiling, vocalising, eye-‐contact etc.

-‐ Seeking physical proximity: moving or turning towards another person to indicate intention to communicate.

• D.

-‐ Anticipation: demonstrating anticipation of a word, phrase or sound effect.

-‐To show contingency awareness on the resonance board.

• E. , L. and A.

-‐ Gaze alternation: looking from person to person.

-‐To show contingency awareness on resonance board. -‐Persevering by repeating actions

-‐Early problem solving.

Description:

Activity Description Focus

Hello Introduction to the session -‐Beginning

-‐Becoming alert, aware

-‐Gaining eye contact, attention.

Bacon and eggs

students on parachute -‐Visual tracking of faces and parachute

-‐Listening, -‐Anticipating -‐May indicate ‘more’

Sausage roll Rolling students on blanket -‐Visual tracking of blanket -‐Listening,

-‐Anticipating -‐May indicate ‘more’

Rocking Rocking students side to side to the tune of row your boat. Then rock forwards and back,

-‐Listening, -‐Anticipating -‐May indicate ‘more’

Body surfing -‐Listening,

-‐Anticipating

-‐Indicate up, down, more, again

Crawling -‐Listening,

-‐Anticipating -‐May indicate ‘more’

Stroll on

blankets -‐May indicate ‘more’

Finishing -‐Goodbye gently with parachute -‐Finish

-‐Calming, relaxing -‐Anticipating ending

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Health and Safety for adults

For swinging activities

• Use slow and smooth movements. Hurried, jerky movements can strain the muscles in your back.

• Keep your body facing the object/student while you lift it. Twisting while lifting can hurt you back.

• Keep the load close to your body. Having to reach out to lift and carry an object may hurt your back.

• “Lifting with your legs” should be done only when you can straddle the load. To lift with your legs, bend your knees,

not your back, to pick up the load. Keep your back straight.

• Consider how many staff can lift child safely.

• One person takes the lead and count “1,2,3 lift”.

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Health and Safety for adults

For carrying children on backs

• Warm up. Stretch your legs and your back before lifting anything.

• Don’t overdo it. Don’t try to lift something to heave for you. If you have to strain to carry the load, it’s too heavy.

• The strongest place is across back on hips.

For rocking

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Sxxx is an inquisitive person who is aware of the daily routines of school. Sxxx is able to use actions to make changes in her environment and she responds to interesting events around her. She is making progress in her use of switches/vocas and can use them to get attention. Sxxx is aware of sequences in her immediate environment and is using this knowledge to anticipate, to take turns and to look at objects or people that she wants. She also tries to interact with her immediate environment.

Potential Learning Outcomes

• To use eye-‐pointing to make choices for preferred activities, clothes, etc. To modify her action when repeating action does not work.

• Sxxx lives with her mum, dad and sister.

• She has epilepsy but rarely has seizures. If you see her have a seizure, please

inform a member of the class team or a nurse immediately.

• Sxxx has had a gastrostomy, which means she eats through a tube in her

tummy. She has tasters of blended food and has thickened drinks.

• Sxxx is dependent on others for all her care needs such as feeding, drinking,

going to the toilet, washing, dressing and undressing, etc.

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Overview of Activity Cards

Key:

Awareness Sept 2012 Sept 2013

1. Recognise an obvious change happening very close to self

Practising a skill Practising a skill

2. Recognise when a stimulus starts and stops

3. Accept stimuli for an increasing amount of time

4. Respond to a widening range of stimuli

5. Anticipate stimuli that occur over and over again

Learning a new skill Practising a skill

6. Respond to a range of stimuli that are quieter / less obvious

6a Read a book with a partner Learning a new skill Learning a new skill 7. Transfer attention from one stimuli to another

Learning a new skill Learning a new skill

8. Locate a specific stimulus against a busy background

Extending a new skill Extending a new skill

Control

Sept 2012 Sept 2013

1. Make things move deliberately with gross (big) movements

2. Make things move deliberately with finer (small) movements

3. Persist in making simple toys do something

4. Operate a toy that requires a single action

5. Activate toys deliberately, using different movements for different toys

Extending a new skill Learning a new skill

6. Shift attention between different objects / actions

7. Manipulate objects purposefully

8. Push buttons to make a toy work

9. Look for favourite item when hidden

Practising a skill

Learning a new skill

Extending a new skill

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deliberately hidden)

11.Open containers to find objects

Exploration

Sept 2012 Sept 2013

1. Use their senses to register interesting events around them

2. Locate a moving stimuli

3. Turn to objects and sounds that are activated but in one place

4. Make things happen when they move randomly

5. Activate toys that provide an interesting effect randomly and without connecting the cause to the effect

Sequence & Pattern

Sept 2012 Sept 2013

1. Take turns in repetitive games where the adult stops for a response

1. A. Intensive Interaction Practising a skill Practising a skill 2. Take turns actively

3. Choose between two or more motivating items

4. Operate toys that require more than one action to complete

5. Operate toys that need to be pulled apart and put together

6. Follow objects that move within the toy

7. Put objects into a container one at a time

8. Select preferred item from a mixture of objects in a box

9. Look at the bottom of a sliding / tumbling toy for the object to appear when it can’t be seen travelling down

10.Use objects that require two or more actions to complete

11.Use early problem solving for a familiar event

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20 12.Solve simple problems where understanding the

pattern in important

Lll Routines 1. Sept 2012 Sept 2013

2. Attend to stimuli in a busy classroom

3. Attend to stimuli further away

4. Anticipate routine events

5. Recognise familiar places

6. Explore objects that are used in familiar routines

7. Respond to object cue

8. Select appropriate resources for a familiar routine

9. Assist in putting away resources used in a familiar routine

10.Use objects and materials according to their function

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Locate a specific stimulus against a busy background

Activity

1 find favourite toy in a box of several toys

2 turn to name in a noisy room

Resources

Light box, sound box, tactile box, messy play box, music box, and the

anticipation box.

What to look for

1.f When hiding a favourite item in a box of several items • Eye pointing

• smiling

2. When calling the student’s name look for:

• a change in activity level or facial expression • movement of eyes, lips, tongue

• vocalisation • tensing/relaxing

• movement of arms/legs/fingers

Who can do the activity

Additional guidance

Pupil Education Profile Tactile profiles

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Control 1

Students should be given opportunities to:

Make things move deliberately with gross (big) movements

Activity

Arrange items so that students can cause a change by using arms or leg movements

eg: knock mobile, kick bells,

swish water push a balloon

Resources

Light box, sound box, tactile box, messy play box, music box, and the

anticipation box.

You can use the washing line to attach tactile objects for the students to use.

What to look for

Arm/ hand movements

The student looking at the item and their hands Smiling at the effect of the action

Who can do the activity

Additional guidance

Pupil Education Profile Tactile profiles

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Switches and position

Peter uses touch cues on his switches to help cue him into the activity.

Black felt cover – Connected to something to make it work

Bubble wrap cover – Connected to something to make it work

Fur cover – Not connected to anything, this switch always does nothing.

If Peter is using 1 switch it should be placed in the middle of his beanbag tray. If the tray is not available it can be placed on his lap as in photo column 1, but the best position is shown in both photo column 2 and 3.

Switches that can be used

Jelly bean switch Big mac

Computer programmes that can be used

Big Bang – colour change

SENSwitcher – press 1

Jelly bean attached to the lights and switch toys

Supporting the student

Peter needs verbal prompting when using his switch.

Peter may need some physical prompting this is done by using hand over hand strategies (see touch profile)

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Peter -‐ Touch profile

Please support me to explore items INDEPENDENTLY – Use minimal physical

prompting!

I can independently

explore sensory items as

shown opposite

Support and preferences…

I need more verbal support to explore wet, small and sticky items….

TOUCH CUES!!

Touch the back of my head lightly with my neck brace and I will bring my head forward.

When taking off my top/coat, make sure the arms holes are accessible so I can pull my own arm through

When putting my top on make sure I can push my own arms through the arm hole with minimal support.

When supporting me to explore wet and sticky items, talk to me! It is best to support me with one hand under my elbow and one under my wrist, leaving my hands free to explore…

CURRICULUM FOR PUPILS WITH PROFOUND AND MULTIPLE LEARNING DIFFICULTIES