Phase III: Child with Visual Recognition Difficulties

My friend is a parent of a child with CVI with visual recognition problems. On the CVI Range, he scores in Phase III (Roman-Lantzy). She constantly describes the impact of CVI on her son that she witnesses every single day. These children with visual recognition problems due to CVI have really, really good central vision use that is consistently used. Because they are looking, people think they have visual access just like we do.

This is her story about a family trip to Montreal. Of course, Omer really doesn’t care for these adventures into noisy, busy and new environments where objects and people are not known and therefore not understood. CVI is an issue of visual recognition after all. He wants to stay in the hotel room that is quiet with few people moving around. He understands and can visually predict the bed, bureau, TV and chairs. He knows the people in the room are his family so that reduces the stress. Because the family understands this difficulty, they picked a quiet restaurant for lunch.

On the table at the quiet restaurant, Omer he saw a glass of room temperature water with bubbles.

 

Omer never saw the bubbles in a glass of water before. A few weeks prior, he had seen and experimented with putting salt into water and drawing on that experience, thought the bubbles were salt. Pretty smart but wrong…

For kids with CVI and visual recognition problems, it takes so long for them to visually process newly seen events and materials. Omer was working so hard to close the gap of information that he missing. He is desperately trying to link previous information to this novel visual target.

Omer never saw the bubbles in a glass of water before. It was his first time seeing it and he was fascinated! He asked his mother to take a picture of it so he could zoom in for a good look and verbal explanation.

I am so proud of Omer’s advocacy! What I do worry about is what is number of times in his day that he encounters items, people and events he doesn’t understand and the we, with perfect vision, forget to make accessible?

Advertisements

Chose Vision for IEP Eligibility

Vision is the primary learning mode for children with perfect vision. Vision gathers information quickly, links previous learning to new learning and links information from all the other senses for a full and complete understanding.

We know that for children with CVI, vision is the primary disability. For children with CVI, their visual impairment impacts all access to all of the general education curriculum. Their visual impairment impact all access to all of the special education curriculum.

Identifying the student with CVI and determining eligibility as “Vision” ensures that a teacher of students with visual impairments is part of the team and that there is consideration of the Expanded Core Curriculum. The Expanded Core Curriculum addresses the Unique Disability-Specific Needs of a child with a visual impairment.

For a child with CVI:

  • Their lack of visual attention and visual recognition limits the effective gathering of information about how the world works.
  • Their lack of visual attention and visual recognition limits the effective gathering of information about how the people in the world behave.
  • Their lack of visual attention and visual recognition impacts their connecting, categorizing and classifying of information.
  • Their lack of visual attention and visual recognition limits their understanding of sound sources.
  • Their lack of visual attention and visual recognition requires direct experiences in natural environments.

The Expanded Core Curriculum includes these 9 areas:

  1. Compensatory skills
  2. Orientation and mobility skills
  3. Social interaction skills
  4. Independent living skills
  5. Recreation and leisure skills
  6. Career education
  7. Use of assistive technology
  8. Sensory efficiency skills
  9. Self-determination skills

This is not an extra curriculum. This is an essential curriculum for the child with visual impairment. These are skills that everyone needs to live and work successfully to their full potential. The critical difference for our children with CVI is ACCESS to these 9 skill area. Children with perfect vision begin their exposure to the Expanded Core Curriculum at birth. Children with CVI must have the same consideration.

Children with and without additional disabilities can have Expanded Core Areas addressed in their programming due to the absence of or reduction of incidental learning.

Children with CVI

  • lack access to all visual information which optimizes all the learning for their peers with perfect vision.
  • lack access to the same number of repeated opportunities for visual information to reinforce concepts which optimizes all learning for their peers with perfect vision.
  • lack access to visual experiences to link new information to old information which optimizes all learning for their peers with perfect vision.
  • lack the ability to access and practice continuously in naturally occurring environments which optimizes all learning for their peers with perfect vision.

CVI is a neurological condition but is manifests in a visual impairment. This visual impairment is the issue for all learning. For the eligibility section of the IEP, chose “Vision” and the primary disability and “Neurological” as the secondary disability.

Bring Vision to the forefront for all learning.

The Neuroscience of Reading

As people suggest methods for our children with CVI to learn to read, I wondered what does the brain need to do in order to learn to read?  I found a local researcher, Maryanne Wolf of Tufts University who wrote extensively about the neuroscience of reading in her book Proust and the Squid.

As it turns out, the brain needs to do quite a lot. It certainly requires a high degree of sustained visual attention, which can be problematic for many of our children with CVI.

Reading requires the whole brain including the occipital lobes, parietal, frontal and temporal lobes. The brain needs activation in both hemispheres and needs the “language areas” of the brain to be engaged and active. There are steps to reading function from decoding to understanding what is read. This reading “thing” is quite complex which is no surprise given how complex the brain is!

When we apply reading methods for our students with CVI, we need to apply methods to the child not decide that all methods work for everyone. We need to be diagnostic. What is working? Why is it working and under what conditions? Is it working at all? What can we do to improve this complex process that includes learning to use vision and to build reading skills?

No one of us serving students with CVI can know everything. We can certainly educate ourselves but will not be experts in everything. We must seek out and collaborate effectively with experts. In this case of reading, we need to partner with reading specialists as we apply any techniques for learning to read.

One size will not fit all because every brain is different and learns differently.

 

 

Judy Endicott: Reading Specialist: CVI

This is a great podcast by a reading specialist putting ideas directly into practice for her grandson with CVI. Another wonderful podcast from Kaleidoscope by Jessica Marquardt.

http://thecvipodcast.libsyn.com/helping-river-read-judy-endicott-episode-8?fbclid=IwAR0odiH7Ld8UT9ODYz-EbP9OQrMty2uyGVDVUm7G5WdkQ2PXe656YPknCEo

How are you deciding?

The caseloads for TVIs are large and overwhelming. I have been a TVI for 40+ years so completely understand that. I think the danger in deciding the student with CVI deserves less direct and consult service than the student learning Braille is the problematic thing for me. It gives the feeling that the children with CVI are not really visually impaired. You know, of course, that is not true. That type of thinking is driving some states to mandate service to Braille students while writing policy to only serve student with CVI monthly and only in a consult model.

This shows a great lack of understanding of CVI as a visual impairment. It ignores all the building evidence of visual improvement due to visual neuroplasticity. We should be making service decisions based on children’s functional vision and based of children’s assessed need.

Dangerous stuff when we start separating students needs based on the location of the condition location: eye or brain. It limits the professional determination for direct and consult service based on assessed functional, individual needs. We do not determine service based on the fact that the child has an ocular or cortical/cerebral diagnosis. Not now, not ever and certainly not when the population numbers of students with CVI continues to explode.

Supporting Language for Salient Feature Understanding

In the CVI world there is great emphasis on salient feature support for children with CVI (Roman-Lantzy). This is the consistent visual description language that is used to help children with CVI understand what they see.

It is also important to remember that children with visual impairments often lack understanding of the basis of these language concepts.

They lack understanding of the meanings of position/directional words and any adjectives describing size, shape, number and sometimes colors.

Adjectives used in this salient feature language such as “long”, “tall”, “flat”, round”, “curvy”, “pointy”, “floppy”, “wagging”, or “skinny” may be meaningless without direct teaching of these concepts.

Position words: used in this salient feature language such as “middle”, “over”, “under”, “top”, “bottom”, or “upside down” are irrelevant without the context for position in space that is taught and directly experienced.

Shapes: used in this salient feature language such as “rectangle”, square”, “circle”, “triangle”, or “center” lack meaning without tactile and visual exploration directly with real items of those shapes.

Number and Size: used in this salient feature language such as “two”, “one of each”, “single”, “short”, “large” are not well understood without direct and repeated teaching of number and size that children with typical visual skills understand through everyday incidental visual experiences. Think about this example of everyday incidental interactions that teach number, quantity and size:

Mom has 3 cookies: 2 small and 1 larger one. She gives 1 small cookie to Billy. Billy sees that mom now has 2 cookies: 1 small and 1 larger. Billy, of course, notices that mom still has “more”: the larger one and a small one while he has the other small cookie.

Children must have multiple understanding of words. If the concept is long, the child must learn that there are multiple kinds of long, that is not a narrow meaning.

“Long” can mean:

  • A distance
  • A length of time
  • Many (as in “a long list”)
  • Long sounds
  • Long hair
  • Long item (as in “long ruler”)

Without directly teaching these concepts for essential language and cognitive understanding, salient feature language is empty language with minimal meaning behind the words.

We must build concepts with direct teaching with hands-on experience with real materials in 3D. Providing learning materials in 2D without this direct teaching will not provide these concepts.

Salient feature language can not be the support we want for building children’s visual understanding without doing this background work to solidify the understanding of the words and the concepts.

https://www.tsbvi.edu/curriculum-a-publications/3/1069-preschool-children-with-visual-impairments-by-virginia-bishop

Wobble Stool: Meeting Students Need for Movement

In a school I worked in, there was a grant written for the first grade to buy these Wobble Chairs for the whole class. It got me thinking about our students with CVI who need to move to see better. Might this simple solution be the answer to keep students with CVI in place but give them the movement they need?

These are not expensive at around $50. Not a bad deal just to save some poor child from the continued negative feedback of “Sit down” that they hear way too often. Comes in all sizes.

https://www.amazon.com/Active-Kids-Chair-Pre-School-Elementary/dp/B075K8BJ3S/ref=asc_df_B075K8BJ3S/?tag=hyprod-20&linkCode=df0&hvadid=233493884306&hvpos=1o1&hvnetw=g&hvrand=8640031681161524922&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9001859&hvtargid=aud-466360936450:pla-385768920414&psc=1

 

 

Matt Tietjen Webinar: The CVI Umbrella

This is a wonderful webinar by Matt Tietjen available from Perkins elearning

http://www.perkinselearning.org/videos/webinar/cvi-umbrella-community-ideas

As Matt says: “Teaching and supporting children with CVI is a richly rewarding experience that requires a joyful, fervent commitment to continuous learning. Fortunately, our field has many wonderful mentors who have dedicated their careers to furthering our understanding of CVI. In this conversation, I will share an integrated understanding of their ideas in the hope that such an approach will enrich your CVI journey as it has enriched mine”.

We are all on the path to learning more about CVI. Matt shares his journey and idea here!

Spread the word! CVI Awareness! Awareness is the first step in advocacy!

For those not familiar with the color highlighting around words like “AWARENESS” in this sign, this is a method developed by Dr Christine Roman-Lantzy. It it meant to draw the visual attention to the word shape and salient features. Although in this example all the words are capital letters, you would not use all capital letters in reading programs with students.