Powerpoint Books: Matching to Assessed Visual Needs

Literacy is so important for every child. I love making Powerpoint books for my students with CVI. You can make these for the class as a whole based on a thematic unit or make individual books tailored to each child’s visual needs and preferences.
Using Powerpoint books allows me to use strategies matched to the child’s assessed visual needs using the CVI Range (Christine Roman-Lantzy 2007)
Color: I use the assessed color preferences that I has discovered in my assessment.
Movement: I can insert slight movement as needed using an inserted film clip. I also like to insert films to build cognitive understanding. If the child will look at a plastic toy fish, I do not want they to believe that “fish” are hard plastic, non-moving things. I want to build understanding of how they move, where they live and to have the child understand that fish come in different colors and shapes. I can insert a film clip of fish in a fish tank. I can talk about how fish are alive, breathe, have different colors, swim in water and how they move. Children with typical vision have this information without direct teaching. I want my students to have the same access.
Latency: The images on the pages can stay present for as long as a child needs.
Visual Fields: The device using the Powerpoint can be placed in the best visual field. This is often at eye level.
Complexity: Powerpoint books allow me to choose a non-complex background for each slide page. If I take my own photographs or grab images from Google, I can Edit and erase all complexity before I insert the picture. If I take film, I can make sure that film is non-complex.
Lightgazing: Because the Powerpoint is created on a computer or backlighted device, the child’s need for light is satisfied.
Distance Viewing: The device playing the Powerpoint can be placed at the child’s assessed best visual distance.
Visual Reflexive Responses: No strategy addresses a reflex. This is a characteristic of CVI but not one we program for.
Visual Novelty: Children will look at familiar items better than non-familiar ones. Using pictures of familiar items and creating books about familiar topics, events or predictable sequences are much more likely to draw a child’s visual attention and interest. Remember that all children like predictable books!
Visual Motor: Visual attention is important for literacy but the ultimate goal is always independence to control the book and choice of books. With the ability to turn to the next page or to indicate a desire for a different book is often visual motor task. To encourage visual motor, there must be an access method that is matched to the child’s assessed visual skills to find and reach.

Here is a Youtube explanation of how to make the Powerpoint book https://www.youtube.com/watch?v=tYQCwowU8sk

Toys for the Holidays

As we think about gifts for our children with CVI, we want to pick toys and materials for fun and learning. First and foremost, children with CVI are children. All children benefit from play as the basis of their learning. It is essential that our children have those opportunities carefully created and frequently available. Think about a child with typical vision. They have access all the time. Wouldn’t it be great to have teams look across the child’s day and make sure our children with CVI have visual and play access all the time?
These play opportunities need to be matched to children’s assessment results from the CVI Range (Roman-Lantzy).
Certainly for children in Phase I and Phase II, as measured on the CVI Range (Christine Roman-Lantzy 2007), toys and materials that would be best would include:
• A toy that includes the child’s favorite color as a component in a less complex toy surface.
• Lighted toys
• Movement that is predictable, not too frantic.
For the play environment:
• We want fewer toys to look at matched to their assessed tolerance.
• We want non-complex backgrounds so the toy really stands out.
• We want the toy to be in the child’s best visual field at eye level.
• We want toys close matched to their visual abilities for distance.
• We want an activation method for the toy. This might be a switch that the child can accidentally hit, learn and then purposefully hit. It might be a toy that makes a visual change or a toy that makes a noise when it is hit. Children in Phase I might not be reaching much yet but we need to present the opportunity to activate to build reaching. Far too many toys for children with CVI rely on passive looking and no expanded access ability for the improving vision and visual motor skills.
• We want toys within the child’s arms’ length and arm movement abilities. If the child has limited arm movement, we must place the activation method near the hand/arm and have another part of the toy within their visual field (“I move my arm and I see this visual event”).

Supporting Understanding of the Auditory Environment

Children with CVI have difficulty seeing things at distance. They tend to be “close lookers”. This can last well into Phase III as measured on the Christine Roman-Lantzy CVI Range 2007. If they do look to distance events, they struggle to understand what they see. Interestingly, when children do begin to look for sounds sources, they tend only search for familiar sounds from visually familiar materials. They don’t seem to even try to look for the sources of unfamiliar sounds from visually unfamiliar materials.
In learning environments at home, in the community and at school, students are surrounded by sounds. Students with typical vision hear a sound, turn to look for the sound source and determine whether there is a threat in their environment. They alert, find the sound source and return to activities, regaining attention to learning.
Because children with CVI lack this ability to checkout the sound, to checkout whether there is a threat or not, we need to carefully support and build that environmental sound understanding. Only then can they return to learning. We want to connect their visual and auditory understanding of their distance environment through planned exploration at near.
This is a statement I include in all my IEPs under methodologies:

“Support Susan’s understanding of environmental sounds by bringing sound sources to her, by traveling to the sounds to explore them and by interacting directly at near with the items that are making sounds. Allow Susan to make the sound if possible to connect the visual information to the auditory event”.
Example: If the door slamming made the noise, have the child slam the door themselves. Verbally label the object, the door, and the action, slamming. Later when slamming door happens, it can be identified and labeled.

Offering: Face to Face Perkins School for the Blind CVI Class

Starting January 21st, 2017, I am teaching an onsite CVI class at Perkins School for the Blind. It is a three day workshop. This course focuses on Cortical Visual Impairment (CVI): causes, assessment and strategies for access and improvement of vision for students with CVI.

Classes run three Saturdays from 8:30-4:00 with lunch included:
January 21
January 28
February 4
Snow day makeup: February 11th (Welcome to New England!)
Participants can earn microcredentials as well as one of these needed credits:
• 24 ACVREPs
• 24 PDPs
• 1.8 ASHA CEUs
• 1.8 AOTA CEUs
• 24 CEs

Here is the link for more information: http://www.perkinselearning.org/earn-credits/onsite-training/cortical-visual-impairment-mazel

Teacher of Students with Visual Impairments: Mandatory Class for CVI

The class about CVI offered by University of Massachusetts Boston has been an elective for teachers in training learning to be Teachers of Students with Visual Impairments. I am so pleased and proud that the Vision Studies Program at UMASS has made this an MANDATORY part of their curriculum for TVI training. I believe this is the first in the country! Well done UMASS! It is a great step forward for our growing population of student identified with CVI. These new TVIs will graduate and be familiar with the unique assessment, environmental adaptations, specific interventions and program planning for children with CVI!

Inservice about Peripheral Vision

My students in Phase I and into early Phase II as measured on Christine Roman-Lantzy’s CVI Range, use their peripheral vision for looking. I struggled to help staff and parents understand exactly what this means as far as visual accessibility of learning materials for the child. I devised an inservice for staff and parents that simulates what kids see when they use peripheral vision. Using this, staff and parents can really live that inaccessibility.

I place people into teams of two. One person on the team is “has” CVI with only peripheral vision use (Phase I and early Phase II). I ask them to focus on a target in the room and not turn to look at any materials their partner will present.

The other team member shows their partner with CVI three kinds of learning materials in their peripheral field:

  • A 3D object
  • Pictures from a book
  • Communication icons
  • Words in large print

I ask the peripheral vision user to tell me what they can see during each presentation. It becomes so clear that using peripheral vision, the child can only see color and vague shape.

This inservice, yet again, gives me an opportunity to talk about the child’s assessed functional vision. I have the opportunity to again stress the possibility of improvement for children with CVI. Working with accessible learning materials with environmental adaptations matched to the child’s CVI Range results (Christine Roman-Lantzy 2007), will build visual skills towards that ventral stream use that we all want for the child but for now, these kinds of learning materials are inaccessible.

The inservice provides the experience of inaccessibility.

Understanding Color in the Brain

I always find it so exciting and encouraging when brain research about the visual system continues to unwrap the great mysteries of the brain. This understanding can only move us forward in understanding CVI and in assessing whether interventions are working. I am deeply interested in why my children behave the way they do. Here is a recent article from Spectrum MIT, a publication from Massachusetts Institute of Technology: http://spectrum.mit.edu/fall-2016/color-decoder.

Non-Complex Concept/Choice Board

To reduce complexity on a concept/choice board, I used corrugated black plastic to create the board.  I used black Velcro so the Velcro would not become another item in the array. (It disappears against the black plastic).


I wanted to be able to notice any visual behaviors so created a window. I was concerned that my eyes and face would become another item in the array. Using black screen like the kind used in window screens, I covered the peek hole. Now this board can be held up at the child’s best distance and at her eye level. I can watch exactly where she is looking and at what she is looking no matter how quickly she looks. I can reach around the board and create movement to draw her visual attention to the described item.

Version 2

This is really helping the team understand whether this child understands the visual information, the concept being discussed and or the choices being made. I can present 1, 2, 3 or 4 icons on this board depending on the child’s assessed array tolerance using the CVI Range (Roman-Lantzy 2007)

Ultra Thin Lightbox

I need backlighting for my students with CVI so much of the time. I was frustrated by the cumbersome American Printing House lightbox for certain adaptations to the curriculum.  I just ordered one of these very thin light boxes for my students from Amazon. This one is just great. The “plug in” one is $39.99 but you are tied to a computer USB port or plugged in the wall. The rechargeable version is $79.99 and has the benefit of portability. It is extremely lightweight. I so appreciate light weight as I travel to multiple schools! Image the ability to take this everywhere in the community to support visual skills!




Lack of Visual Access Masks Language/Cognitive Abilities

Young Jack, who has CVI, is in school where the team was using pictures in his communication system. Jack seemed to show no understanding that the picture of the “spoon” represented “snack”. When he wants snack he whines or cries until someone familiar with his limited communication gets him a snack.  It is so hard for Jack to show adults what he knows or understands. His abilities to communicate using symbolic representations seems severely limited.

The new TVI assessed Jack using the CVI Range (Roman-Lantzy 2007) around the 10 characteristics. She determined that 2D pictures were visually inaccessible for this child. She advocated for the change from 2D photographs to 3D symbols for his communication.

With this new 3D symbol system, “snack” is represented as a spoon mounted on a black 5’X7” card.


Jack began to show adults that he indeed understood the new 3D symbol system.

  • Jack smiles when seeing the 3D symbol for “snack”.
  • Jack consistently chooses the “snack” symbol when given a choice of “snack” or a foil. (A foil is a meaningless object or a non-preferred object)

For more about “foils” see    http://www.swaaac.com/files/assessandimp/aacbasicsandimplementationbook.pdf under “Implementation” section.

  • Jack pulls people towards the snack table when presented with the 3D “snack” symbol.

Jack also began showing similar understanding of other 3D symbols in his new communication system.

3 imbedded symbols

When using photographs, Jack’s abilities to communicate using 2D symbolic representations seemed severely limited until the assessment using the CVI Range (Roman-Lantzy 2007) determined that these 2D photographs were beyond his visual abilities. Creating symbols in 3D that are accessible allows Jack to truly communicate his wants and needs. This ability shows the team what Jack is capable of.

The collaboration between a TVI who understands CVI and the team puts Jack on the road to building communication. Jack looks more capable as he is now able to show what he understands. The team has higher expectations for his learning. The building successes using the 3D symbol system can later be thoughtfully transitioned to photographic symbols in planned way based on his visual understanding.