MOH / K / ASA / 35.03 (G.U.

CARE OF CHILDREN WITH SPECIAL NEEDS

Manual on the
Management
of
Children with Visual Impairment

By

Family Health Development Division

Ministry of Health, Malaysia

September 2003

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 CONTENT

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 Introduction 
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 Material Needed For Eye Assessment And
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1. INTRODUCTION

1.1 Definition Of Visual

Impairment
1.2 Action To Be Taken By
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1. INTRODUCTION


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2. VISUAL DEVELOPMENTAL
MILESTONES

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2. VISUAL DEVELOPMENTAL MILESTONES

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3. BASIC EYE EXAMINATION

3.1 History
3.2 General Examination
3.3 Eye Examination
3.4 Technique on Eye
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3.6 Visual Assessment Record
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 STIMULATION ACTIVITIES
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56
 STIMULATION ACTIVITIES
AGE 6 < 9 MONTHS

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57
 STIMULATION ACTIVITIES
AGE 6 < 9 MONTHS

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58
 STIMULATION ACTIVITIES
AGE 6 < 9 MONTHS

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59
 STIMULATION ACTIVITIES
AGE 6 < 9 MONTHS

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60
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AGE 6 < 9 MONTHS

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61
 STIMULATION ACTIVITIES
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62
 STIMULATION ACTIVITIES
AGE 6 < 9 MONTHS

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64
 STIMULATION ACTIVITIES
AGE 6 < 9 MONTHS

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65
 STIMULATION ACTIVITIES
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AGE 9 < 12 MONTHS

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AGE 9 < 12 MONTHS

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70
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71
 STIMULATION ACTIVITIES
AGE 9 < 12 MONTHS

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72
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AGE 9 < 12 MONTHS

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73
 STIMULATION ACTIVITIES
AGE 9 < 12 MONTHS

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74
 STIMULATION ACTIVITIES
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75
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76
 STIMULATION ACTIVITIES
AGE 1 < 2 YEARS

A. MOBILIZATION AND ORIENTATION

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77
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AGE 1 < 2 YEARS

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79
 STIMULATION ACTIVITIES
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80
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AGE 1 < 2 YEARS

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81
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82
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83
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84
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86
 STIMULATION ACTIVITIES
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87
 STIMULATION ACTIVITIES
AGE 1 < 2 YEARS

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AGE 1 < 2 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

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89
 STIMULATION ACTIVITIES
AGE 1 < 2 YEARS

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90
 STIMULATION ACTIVITIES
AGE 2 < 3 YEARS
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91
 STIMULATION ACTIVITIES
AGE 2 < 3 YEARS
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92
 STIMULATION ACTIVITIES
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93
 STIMULATION ACTIVITIES
AGE 2 < 3 YEARS
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94
 STIMULATION ACTIVITIES
AGE 2 - 3 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

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95
 STIMULATION ACTIVITIES
AGE 2 - 3 YEARS

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 STIMULATION ACTIVITIES
AGE 2 - 3 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

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97
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98
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100
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104
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106
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108
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110
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113
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114
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WKHFKLOG *HWKLPWRIROORZ


 5HSHDWZLWKQXPEHUV


* Play and sing the
alphabets in rhythm








119
 STIMULATION ACTIVITIES
AGE 4 < 5 YEARS
A. MOBILISATION AND ORIENTATION

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  7LHVWKHURSHWRWZR

WRMXPSRYHU FDUHJLYHU SROHVRUFKDLUV
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7RWHDFKFKLOG 3DUHQW  *XLGHWKHFKLOGWR

WRMXPSIRUZDUG FDUHJLYHU MXPSIRUZDUGDQG
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7RWHDFKFKLOG 3DUHQW  *XLGHWKHFKLOGWR

WRZDON FDUHJLYHU ZDONRXWVLGHWKH
LQGHSHQGHQWO\ KRXVH2ULHQWDWH
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 2QFHKHLV
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120
 STIMULATION ACTIVITIES
AGE 4 < 5 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  *XLGHWKHFKLOGWRGUDZ

WRGUDZYDULRXV FDUHJLYHU VTXDUHVDQGFLUFOHV
VKDSHVOLNH XVLQJWHPSODWHV
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VTXDUHVFLUFOHV
WHPSODWH  7DONWRWKHFKLOGDQGOHW
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SHQFLO KLPUHSHDWWKH
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7RWHDFKWKH 3DUHQW *XLGHWKHFKLOGWRZUDS

FKLOGWRZUDS FDUHJLYHU DVPDOOER[
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SDSHU
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7RWHDFKWKH 3DUHQW  *XLGHWKHFKLOGWRIROG

FKLOGKRZWR FDUHJLYHU DQDSNLQ
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  /HWKLPWU\RQKLVRZQ


7RWHDFKKRZ 3DUHQW  7HDFKWKHFKLOGWRXVH Refer Rehabilitation

WRFRORXUThis FDUHJLYHU FRORXUSHQFLORUFUD\RQ Equipment :
activity is for WRVKDGHWKHSDSHU
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low vision
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children)





121
 STIMULATION ACTIVITIES
AGE 4 < 5 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW For buttons:

WRXVHEXWWRQ FDUHJLYHU
 /HWWKHFKLOGIHHOVWKH
SUHVVVWXGV
6KLUWEORXVH EXWWRQVDQGEXWWRQV
KRRNDQGH\H
WURXVHUVZLWK KROHV
 EXWWRQVSUHVV
 *XLGHKLPWREXWWRQ±
VWXGVKRRN
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DQGH\H
  5HSHDWXQWLOKH

FRPSOHWHVZLWKDOOWKH

 EXWWRQV

  /HWKLPGRRQKLVRZQ

  *XLGHKLPWRXQEXWWRQ Refer Rehabilitation
 WKHVKLUWRUEORXVHDV Equipment : - ‘Buku

 ZHOO5HSHDWXQWLOKHLV A.D.L.’
 JRRGDWLW

 

 Repeat the same
 procedure for press
studs, hooks and eyes.


7RWHDFKFKLOG 3DUHQW  %ULQJWKHFKLOGWRWKH

KRZWRKDQJ FDUHJLYHU FORWKHVOLQH
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7RZHO  /HWKLPIHHOWKHOLQH
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WRZHODORQJWKHOLQH


 8VHSHJVWRKROGWKH

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122
 STIMULATION ACTIVITIES
AGE 4 < 5 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  /HWWKHFKLOGIHHOWKH

KRZWRKDQJ FDUHJLYHU KDQJHU
FORWKHVRQ
+DQJHUVKLUW  *XLGHKLPWRSXWRQWKH
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VKLUWRQ
XVLQJKDQJHU 
 *XLGHKLPWRKDQJWKH
 
KDQJHU

 5HSHDWXQWLOKHFDQGR
 RQKLVRZQ
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 







123
 STIMULATION ACTIVITIES
AGE 4 < 5 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RUHLQIRUFH 3DUHQW *XLGHWKHFKLOG

SHUVRQDOFDUH FDUHJLYHU
brushing his teeth.
DQGJURRPLQJ WRRWKEUXVK
D 3XWORRVHSDVWHRQWKH
 7RRWKSDVWH
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F 5LQVHWKHPRXWK
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G %DWKH
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FORWKHV D *XLGHWKHFKLOGWR
SRZGHUWKHERG\
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E *XLGHWKHFKLOGWRIHHO
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FDUULHGRXW
G *XLGHWKHFKLOGWRIHHO
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KDLU

124
 STIMULATION ACTIVITIES
AGE 4 < 5 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKWKH 3DUHQW  *XLGHKLPWRWRXFKDQ

XVHRIQHJDWLYH FDUHJLYHU REMHFWEXWVD\DQRWKHU
ZRUG³QRW´ REMHFW¶VQDPH
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ƒ 6D\³7KLVLVDEDOO´


 5HSHDWXQWLOKH
XQGHUVWDQGV
 &RQWLQXHLQWHUDFWLQJ
ZLWKKLP3UDLVHKLP

7RWHDFKWKH 3DUHQW  (PSKDVLVHWRWKHFKLOG

XVHRI FDUHJLYHU WKHXVHRI³P\´DQG
SRVVHVVLYH ³\RXU´
SURQRXQV 

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ƒ ³7KDWLV\RXUKDW´

 5HSHDWXQWLOKH
XQGHUVWDQGVWKHXVHRI
WKHZRUGV
 ([SDQGWRWKHXVHRI
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SURQRXQVOLNHRXUWKHLU
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125
 STIMULATION ACTIVITIES
AGE 4 < 5 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKWKH 3DUHQW 7HDFKWKHFKLOGWKH

IXQFWLRQVRI FDUHJLYHU IXQFWLRQVRI
WKHERG\
ƒ H\HV±WRVHH
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ƒ QRVH±WRVPHOO
ƒ HDUV±WRKHDU
ƒ PRXWK±WRHDWWDON




7RWHDFKWR 3DUHQW  JLYHYDULRXVW\SHVRI

UHFRJQL]H FDUHJLYHU IRRGWRWKHFKLOGDQG

WDVWHVDQGLWV QDPHWKHP

QDPH
 $OORZFKLOGWRWDVWH 

 'HVFULEHWKHWDVH

 *HWFKLOGWRUHSHDWWKH 
ZRUG 
 

Examples:
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VZHHW
ƒ 6DOW±6DOW\
ƒ /LPH±VRXU
ƒ %LWWHUJRXUG±ELWWHU
Introduce one taste at a
time 

*Give different types of

food of the same taste



126
 STIMULATION ACTIVITIES
AGE 4 < 5 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  (QFRXUDJHFKLOGWRWHOO

WRWHOOVWRULHV FDUHJLYHU ZKDWKHKHDUV




 3DUHQWVPXVW
UHVSRQGVWRKLVVWRULHV
0DNHLWDQHQMR\DEOH
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127
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS
A. MOBILISATION AND ORIENTATION

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  3DUHQWDQGFKLOG

WRJDOORS FDUHJLYHU VWDQGVLGHE\VLGH
VLGHZD\V 3DUHQWKROGVWKH
5RSH
FKLOG¶VOHIWKDQG

 3DUHQWPRYHVKLVOHIW

OHJVLGHZD\DQGDW
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OHIWOHJDVZHOO
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ULJKWIRRWFORVHWRWKH
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 5HSHDWWKLVXQWLOWKH
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 5HZDUGDQGSUDLVH
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7RWHDFKFKLOG 3DUHQW  &DUU\WKHFKLOGXS 

WRVZLQJDORQJ FDUHJLYHU WRZDUGVWKHEDU
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 VZLQJLQJQRZ´
 







128
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS
A. MOBILISATION AND ORIENTATION

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  &KLOGKROGVWKHODGGHU 

WRFOLPEXSDQG FDUHJLYHU ZLWKERWKKDQGV
GRZQWKHODGGHU
/DGGHU  *XLGHVWKHFKLOGWR
SXWKLVULJKWIRRWRQ
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129
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS
A. MOBILISATION AND ORIENTATION

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  6KRZFKLOGWKH 

WRZDONZLWK FDUHJLYHU ZDONLQJVWLFN

ZDONLQJVWLFN
:DONLQJVWLFN $OORZFKLOGWRIHHODQG 
H[SODLQWKHXVDJH 


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 ([SODLQWKH
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  Walking stick is
 available at Malaysian
 Association For The
 Blind

 * Adjust the length of
 walking according to
 child’s height
 

 






130
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  /HWWKHFKLOGVSUHDGKLV

ILQJHUVSOD\ FDUHJLYHU ILQJHUV*XLGHWKHFKLOG
XVLQJYHUEDO E\YHUEDOFXHV
FXHV


 *XLGHWKHWKXPEWR
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HWF¶


 'RLWZLWKERWKKDQGV


7RWHDFKFKLOG 3DUHQW  *LYHWKHFKLOGDSLHFHRI

WRIROGSDSHU FDUHJLYHU SDSHU
LQWRVTXDUHV
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UHFWDQJOHVRU
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 *XLGHKLPIROGWKHSDSHU
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131
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  *LYHWKHFKLOGDVDIHW\

WRRSHQDQG FDUHJLYHU SLQ7HOOKLPDERXWWKH
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 *XLGHKLPWRRSHQDQG
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 ,QWHUDFWZLWKKLP


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GUDZ FDUHJLYHU
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132
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  *XLGHWKHFKLOG¶VKDQGWR

WRWHDUSDSHUV FDUHJLYHU WHDUWKHROGQHZVSDSHUV

2OGQHZV 
SDSHUV
 *HWKLPWROLVWHQWRWKH
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 /HWKLPGRRQKLVRZQ




7RWHDFKFKLOG 3DUHQW  *LYHWKHFKLOGKLVVRFNV

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6RFNVVKRHV
VKRHV
ZLWK9HOFUR  *LYHWKHFKLOGWRSXWRQ
KLVVKRHVDQGVQDSRQ
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 :KHQKHLVFRQILGHQWOHW
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 7HDFKFKLOGWRUHFRJQL]H
OHIWDQGULJKWVKRHHJ
ULJKWVKRHKDV9HOFURRQ
WKHULJKWVLGH
Refer Rehabilitation
Equipment : 
- Buku A.D.L. for tying
shoelace and velcro

133
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW *XLGHWKHFKLOG¶VKDQGWR

WRUHFRJQL]H FDUHJLYHUPLON
ƒ RSHQDPLONFDUWRQ
GLIIHUHQWW\SHRI FDUWRRQ

IRRGDQGWKH
&HUHDOOLNH ƒ SUHSDUHFHUHDOZLWK
DSSURSULDWH
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ZD\VRIHDWLQJ
WKHIRRG 

ƒ VSUHDGMDPEXWWHURQ
WKHEUHDG


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SUHSDUHV


ƒ LQWHUDFWZLWKKLP


7RWHDFKFKLOG 3DUHQW *XLGHWKHFKLOGWRSXWDZD\

WRSXWDZD\KLV FDUHJLYHU KLVIROGHGFORWKLQJLQWRKLV
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134
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  *XLGHWKHFKLOG¶VKDQGWR

WRVZHHSWKH FDUHJLYHU KROGWKHEURRP

IORRU
%URRPUXEELVK  
SDQ


 *XLGHKLPWRVZHHSWKH
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LQWRWKHUXEELVKSDQDQG
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135
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  /HWKLPNQRZKLVGDWHRI

WRNQRZKLV FDUHJLYHU ELUWK
ELUWKGD\GDWH
 *HWKLPWRUHSHDW





7RWHDFKFKLOG 3DUHQW  /HWFKLOGOHDUQKLVKRPH

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DGGUHVVDQG QXPEHUV
WHOHSKRQH
 $VNKLPRQDQGRIIXQWLO
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136
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RWHDFKFKLOG 3DUHQW  *LYHDZDOOFORFNWRWKH Refer Rehabilitation

WROHDUQWKH FDUHJLYHU FKLOG5HPRYHWKHRXWHU Equipment - Clock
WLPHRIWKH FRYHULQJJODVV
:DOOFORFNZLWK
GD\
UDLVHGXSGRWV  *HWKLPWRIHHOWKHFORFN
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  7HDFKKLPKRZWRWHOO
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 WKHWLPHDVKHIHHOVWKH
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 /HWKLPOHDUQWRGRLWE\

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 *You can mark the clock
 with ‘raised’ beads

 3 beads to mark 12

  2 beads to mark

3,6,9

  1 bead to mark

1,2,4,5,7,8,10,11









137
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

DEVELOPMENT

$,06 $,'6$,'(6 5(&200(1'(' ,//8675$7,216

$&7,9,7,(6

7RRULHQWDWH 3DUHQW :LWKJXLGDQFH

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 * Expose the child to the
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138
 STIMULATION ACTIVITIES
AGE 5 < 6 YEARS

B. MANIPULATIVE SKILLS, PSYCHOSOSIAL, LANGUAGE AND HEARING

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7. REFERENCES &
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8. ACKNOWLEDGEMENT/
CONTRIBUTORS

List of Contributors



'U+M0RKDPDG6KDULIELQ)DKUXGGLQ 'U*RK3HN3LQ
Opthalmologist, Opthalmologist,
Hospital Ipoh, Hospital Selayang
Perak

'U=DKDULGD%W$EGXO.DGLU 'U6RILDK%W$OL
Opthalmologist, Consultant Paediatrician,
Hospital Kuala Terengganu Hospital Kuala Lumpur

'U)DULGDK%W$EX%DNDU 'U/RR&KHHQ<HQJ
Family Health Medical Officer, Opthalmologist,
State Health Department, Hospital Kuala Lumpur
Perak

'U5X]LDWXQ%W+DVKLP 0GP1RUPDOD%W6DPL
Family Medicine Specialist, 2SWRPHWULVW
Klinik Kesihatan Telok Datuk +RVSLWDO,SRK

0GP&KH5XKDQL%W&KH-DDIDU 0GP&KH$ULQD+DQLP
Optometrist, Optometrist,
Hospital Kuala Lumpur Hospital Selayang

0GP.KRU3KDLN(DQ 0U$]PDQ%7XNLUDQ
Optometrist, Occupational Therapist,
NGO U.S.M. Kelantan

0U0RKG=XONLIOL%$EGXO5DKLP 0U0RKG+DOLPL%=DNDULD
Occupational Therapist, Grafik Artist
Hospital Ipoh Hospital Seremban

0U$KPDG6KDUL]L%+DVVDQ 0GP0DKDQL%W$VXPL
Grafik Artist, Public Health Matron,
Hospital Alor Star, State Health Department Ipoh

0LVV.XHN7R&HHN 0GP$]L]DK%W*KD]DOL
Public Health Matron, Public Health Nurse,
Family Health Development Division, Health Clinic Gopeng
Ministry Of Health

0GP0DMLGDK%W2VPDQ 0GP+DIL]DK%W0G7DKLU
Public Health Nurse, Public Health Nurse,
M.C.H.C Batu Gajah Health Clinis Chemor

0GP+DPVLDK%W0RKG$PLQ 0GP+DIL]DK%W.HFKLN
Public Health Nurse, Public Health Nurse,
Health Clinic Ulu Dedap M.C.H.C Batu Gajah

0GP5XVWLQD%W5DIDL 0GP$]L]DK%W*KD]DOL
Public Health Nurse, Public Health Nurse,
Health Clinic Gopeng Health Clinic Gopeng




151
 0GP5RVQDK%W$OL0XGD 0GP5RVLGDK%W:DKDE
Special Education Teacher St. Nicholas School,
Early Intervention Program, Penang
Malaysian Association for the Blind,
Kuala Lumpur

0LVV3XQLWD$3.RYLQGDUDMRR 
St. Nicholas School,
Penang.





Editors



 '5$PLQDK%HH%W0RKG.DVVLP
  Principal Assistant Director,
Family Health Development Division,
Ministry of Health

 0GP&KHRK6LHZ7LQ
  Public Health Sister,
Family Health Development Division,
Ministry of Health

 0U<DKD\D%0RKG<XVRI
  Senior Medical Assistant,
Family Health Development Division,
Ministry of Health


152