What’s the Complexity? Workshop

This month I attended a full day workshop titled: “What’s the Complexity?” with creator, Matt Tietjen, M.Ed. CTVI. This assessment tool was developed to look at the characteristic of complexity as described in the work of Christine Roman-Lantzy in the CVI Range 2007.

The “What’s the Complexity?” framework takes a close look at the characteristic, Complexity,  that is most difficult to control and the characteristic that seems to effect children’s visual functioning to the greatest degree. It provides a way for parents and educational teams to assess complexity in all forms. It helps parents and teams choose appropriate materials, design appropriate environments matched to appropriate tasks and then to plan across the complete learning day for the student with CVI.

It focuses on all Phases of CVI (Christine Roman-Lantzy) but I believe is most valuable for the students functioning in Phase II and Phase III as they try to access pictures. The “What’s the Complexity?” framework also provides us with a well thought out system to assess the student’s interpretation of images. We evaluate the child’s understanding of photographs of their real items (my spoon), colored photographs of other classes of items (the class of spoons), understanding of realistic or abstract cartoon icons of items (spoons in cartoon form), colored icons (Mayer Johnson spoon) and black and white line drawings (black and white drawing of a spoon).

This is an important new tool for us as we serve our children with CVI. It will help support our recommendations for children’s accessible media. Fantastic!

I understand that a graduate class will be offered in September at Perkins elearning to deepen the understanding for using the “What’s the Complexity?” framework. I will certainly be signing up for this!

 

Morning Meeting Ideas for Children in Phase I

I had a request for some morning meeting ideas for children in Phase I as measured on the CVI Range (Christine Roman-Lantzy 2007). The concepts and vocabulary around “Characteristics” and “Phases” come from Dr. Roman-Lantzy’s work.

The first place to start, of course, is to assess the child using the CVI Range. This is the only functional vision assessment for children with CVI. Understanding the child’s functional visual skills allows you to create goals and objectives and to provide across-the-day accommodations and methodologies to meet those needs.

Phase I:  Goal: Building Visual Behaviors. Providing access to use visual skills around the 10 characteristics.

The child has a favorite color and will only look at simple one colored items. (Color)

  • Materials in morning meeting must meet the color preference. This is not always red o yellow. Your assessment will tell you the preferred color. Because this child is very visually impaired, compensatory skills should also be considered. Items presented must be 3D, real objects NOT PICTURES! 3D objects will provide visual access, tactile input, olfactory input and auditory input.

Pictures are completely inaccessible for this child who is not using central vision   effectively. (Central vision is essential for children to understand any 2D materials).

The child looks at movement or shiny items but does not seem interested in stable objects. (Movement)

  • Materials in morning meeting must meet this assessed need for movement of the presented materials to foster visual use. Shiny items are considered under the Movement characteristic since the reflected light from the surface looks like movement. Movement should be gentle and slow not fast and frantic.

There is no or little reaction to visual threat or touch between the eyes. (Visual Reflexive Responses)

  • Reflexes are reflexes and cannot be taught. There are no accommodations for visual reflexes.

The child fixates briefly but likes light, ceiling fans and movement. (Light gazing and Movement)

  • To foster looking at the presented morning meeting materials, light must be controlled, limiting the child’s lightgazing.
  • Because light is important to encourage looking, light the materials that are presented or use materials that light up.
  • Because fixation is brief, the material must be presented for longer so the child has another opportunity to visually locate.

The child sees things in the peripheral fields but does not react to items in central vision positions. (Visual Fields)

  • Because peripheral fields are stronger than central visual fields, the materials must be presented off center in the best assessed lateral visual field. (The child in Phase I will have a distinct preference for one lateral visual field).
  • The lower visual fields are often not functional well into Phase III so eye level is recommended. Upper fields can also be inaccessible.
  • Make sure the “action” of morning meeting is within their best assessed visual field.

There is visual attention in near space only within 2 feet. (Distance and Complexity)

  • The child can only look at items in near space. The exact assessed distance needs to be respected and materials presented within this distance. At this Phase, this is typically within 18”-24” of the child’s eyes.
  • Give the child a copy of the material being used with other child in turn. This provides visual access for the child even when materials are being presented to other children at greater distances.

The child rarely looks to faces (Complexity).

  • Faces are very complex. This child will have difficulty looking at faces. Be mindful that the child may be attending but not able to make eye contact or even look towards your face if you are talking. Greet them with your name and tell them what you will be doing with them. Call their name before delivering a message or asking a question. Research shows that adults often do not talk as much or as long to children without eye contact. Adults should be aware of this and monitor their behavior with children.

The child sees best in uncluttered, quiet places. (Complexity)

  • Provide quieter environments
  • Create morning meetings of less children so the movement, visual complexity and auditory complexity is more controllable. There is no rule that morning meeting needs to be all the children in one morning meeting. Have several smaller meetings.
  • Provide non-complex backgrounds for all learning materials.
  • Where non-complex shirts. You are the the visual background!
  • Seat yourself in the same position as the child to see what the child sees. You will be surprised how much visual complexity you will notice and need to control.
  • Position this child solidly for best visual skill use.

The child only looks at familiar and favorite toys. (Novelty)

  • Use familiar materials.
  • Use consistent materials to build visual familiarity.
  • Predictable routines in morning meeting will support visual recognition of materials and help children predict the sequences.

The child has a long delay before they turn to look. (Latency)

  • The child will have latency for looking and latency for understanding what is seen. Using the assessment and taking data will help identify how long the child requires for visual attention, which visual field is faster and which visual field has the most sustained visual attention abilities. The material needs to be where the learning is accessible and for as long as the child requires.

 

Visual Experience, Joint Attention and Salient Features

I went to a wonderful workshop this month with Dr. Roman-Lantzy. The topic was “Assessment and Strategies for Children in Phase III” (as measured on the CVI Range Roman-Lantzy 2007).

Some of the many things we talked about included:

  • Visual inaccessibility at distance for children scoring in Phase III (CVI Range Roman-Lantzy 2007)
  • How vision, cognition and language are linked.
  • How joint attention in typically developing, sighted children helps build these visual, cognitive and language skills.
  • How vision, cognition and language skills are based on the child’s experience.

It got me thinking about my own daughter’s visual, cognitive and language development. She was a typical developing toddler with full visual access.

We lived on our sailboat in Boston Harbor. We were surrounded by ducks daily. My daughter would see these ducks everywhere, everyday. (visual experience)

When she looked at or pointed to the ducks, we shared gaze to the ducks and I would label this animal: “Duck” (shared gaze, language)

As she language skills grew, she would begin to point and label them as “Duck” as well (building language and shared gaze).

When we traveled on land, she began to label other animals as ducks. She understood that dogs, cats and other birds we saw were not human but animals (cognitive). She over- generalized that any animal that was not human was a “duck”.

Sharing her gaze and sharing her experience, I pointed out the salient features that made these other animals different and labeled them as different. “No. That is a dog, he has 4 legs and is furry”. (cognitive, shared gaze and salient features).

Very soon, my daughter was able to use her cognitive comparison skills to label each animal she saw with the correct name based on the visual salient features: shape, number of legs, how then moved, where they lived, how they sounded.

For children in Phase III, supporting children’s visual, cognitive and language skills must be carefully planned, based on experience and presented at near by providing supports around salient features. They must be presented in planned, accessible ways due to the inaccessibility of distance events and materials.  This link must be facilitated to build visual, cognitive and language skills by comparing and contrasting visual attributes that are experienced, highlighted and shared.

Importance of Color

So many times I see professionals mark the CVI Characteristic of “Color” as “Resolved” as soon as a child looks at more than a single favorite color. (Roman-Lantzy CVI Range 2007).

This is a great misconception. Marking the Color characteristic as “Resolved” means that color is no more important to the child than to a typically developing peer. (Roman-Lantzy)

Color remains important for many children assessed much higher in the CVI Range. I recently assessed a child in a typical kindergarten. Careful interviewing of parents and his team plus observations and direct assessment uncovered this important information about this child’s color preferences:

Parent/Team Interview (Roman-Lantzy):

  • This child’s parents immediately report “red” as a favorite color. He always picks red clothing, red toys and wants to paint his room red.
  • This child’s teacher immediately was able to state that “red” was this child’s favorite color. When I asked this teacher whether he knew the favorite color for other children in the class, the answer was “no”. (This color preference for this child with CVI was strikingly evident for a teacher with 14 other students in the class!)

My observations and direct assessment revealed:

  • This child looks at all colors and colored patterns.
  • This child does have a distinct preference for the color red for visual attention at near and distance.
  • This child was observed visually locating and then following a peer dressed in red or orange when told to line up, when evacuating the building in a fire drill and when outside on the playground.
  • Told to pick items for decorating a snowman in Art, this child walks completely around the table to chose a red ribbon for the scarf.
  • Walking the hallway to Art, this child was observed to have increased visual attention to red items in the hallway on all planes (materials on the floor, wall, above to the red Exit signs and to children dressed in red walking by).
  • In the Speech session, this child picks red pirate game piece and has great sustained visual attention to the red, lighted spinner.
  • Asked to pick a marker for an activity, this child picked the red marker every time.
  • Asked about a bowl choice, he asked for the red one.

If we know this child has such a strong color preference, we can infuse this color into activities that are difficult for him:

  • Added to the locker hook to hang up his coat
  • Added on the classroom sign-in sheet to highlight where to place his name.
  • To draw his visual attention to salient learning features.
  • Added to the envelop edge to help him place the paper into the folder.

Missing this vital information about color, misses a great learning accommodation for visual functioning.

 

Seeing Movement

Here is an interesting video about a woman with a brain injury. As she recovered some sight, she is first able to see rain since it was moving. She progresses to seeing other kinds of things moving in the world. Movement is so important for some children with CVI!

Blind Woman Who Saw Rain

https://www.youtube.com/watch?v=9ABQ-U6V0tY

 

Perkins School for the Blind CVI Symposium April 7, 2017

Spread the word about this important event! It filled very quickly last year so sign up if you are interested.

CVI Symposium: Best Practices and Current Research presented by experts in CVI

Held at Perkins School for the Blind in Watertown, Massachusetts

Friday, April 7, 2017 8:30 sign-in, presentations 9:00-4:30 

$100.

6.5 ACVREPs, 6.5 PDPs, 6.5 CEs

There will be discussion about current research and best practice related to brain-based visual impairments.

From the website:

Topics and Presenters include: (with more to be confirmed)

  • Visual Processing and the Impact of Damage: What We Know and How We Know

Lotfi Merabet, O.D., Ph.D., MPH

Presenter TBD

  • Collaborative/Coordinate Care – The Importance of an Effective Team

Anne Fulton, Ophthalmologist

Rebecca Davis, parent

Ellen Mazel, Ed., CTVI

  • Literacy and O&M from Phase I to Phase III

Christine Roman-Lantzy, D.

Matt Tietjen, M.Ed., CTVI

Find out more at:

http://www.perkinselearning.org/earn-credits/onsite-training/cvi-best-practices-current-research

I believe this will also be available to watch after the symposium.

Picture Accessibility for Children with CVI

In my work with children, I am often asked about the accessibility of pictures, icons and line drawings as communication systems for children. I especially struggle to be an effective voice around accessibility when my children with CVI look towards pictures but never use central vision to actually “see” and “understand” those pictures. I try to support my opinions with inservice simulations about peripheral looking, as it only provides visual information about general color and general shape. To understand objects, pictures, ions and line drawings, the child must look directly at the image using central vision and shift to the picture’s elements to understand it. At MIT, there are several labs that study various aspects of visual processing. I found this book and ordered it on Amazon for $10. I am finding it so helpful!

Looking into Pictures: An Interdisciplinary Approach to Pictorial Space by Heiko Hecht

Color Highlighting: Luggage Handle Wraps

For color highlighting, I can’t always use my favorite colored duct tap to help students with CVI to visual locate and understand where to grab/where to hold for best access. I found these removable red luggage handle wraps that quickly and easily can be applied to provide that access. In the pictures here in the community, my student who locates the color red best, is using the red luggage handles on a shopping cart in the store and on the bowling frame during a recreational activity. The extra benefit is that these handles have a unique, “squishy” texture that provides a tactile cue.

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Brain Plasticity

I just attended a meeting where the school psychologist stated “This child’s skills have plateaued”. Such old and erroneous information! Even with the scientific evident to the contrary, some professional continue to propagate this brain science myth. This is a dangerous myth. It sets a mindset that lowers a team’s expectations for a child’s continued learning across all skills.

In schools, there continues to be a misconception that brain plasticity is fixed to ages between 0 and 3 years old. While it seems true that the young brain learns and reassigns best, this does not mean that after age three, we do not have the expectation for improvements for all skills including visual skills. The brain has great plasticity all through life so we must expect improvements or we will most certainly not get them! We must continue to provide each child with the needed supports. Of course, these needs are determined after careful assessment using the correct tools that measures where and how the child is functioning. For a child with CVI, the correct assessment for functional vision is the CVI Range (Christine Roman-Lantzy 2007).

Knowing where and how a child is functioning is the only way to provide first: optimal visual access and second: build visual skills. We move from current functioning, determine the next steps and create goals and objective for improvement. The CVI Range provides us with an assessment tool to measures that improvement.

Here are some resources that I shared with that psychologist, parents and the team:

Psychology Today: Brain Plasticity in Older Adults https://www.psychologytoday.com/blog/iage/201304/brain-plasticity-in-older-adults

Dr. Lofti Merabet Looking Inside the Adaptive Brain
https://videocast.nih.gov/summary.asp?Live=16959&bhcp=1