Month: May 2014

Understand CVI and CVI Assessment

I run into many parents, classroom teachers or teacher of students with visual impairments who ask me for ideas about educational programming for their children with CVI. The very first question is “Has a comprehensive CVI assessment been completed?” This would include the ocular assessment to rule out any ocular problems or to identify any refractive errors that might require glasses. Again and again the answer is “no”. Random supports are being used with children with no assessment, no planning and no focus.

This CVI Range Assessment is one assessment for the visual skills in children with CVI. It is not used as diagnostic criteria for CVI but as one important component to identify some important functional vision areas. Dr. Gordon Dutton has the CVI Inventory to look at the visual behaviors of CVI. The TEACH CVI Screenings provide three screening protocols for looking at visual difficulties of children with CVI.

Teachers of students with visual impairments who are serving children with CVI need training in CVI and need to join the path of continued learning about CVI. That valuable training should include understanding the brain, CVI assessments and how to create educational programming for a child with CVI to help with visual access, to build visual attention and to build visual recognition. Would a TVI serve a child with ocular visual impairment without understanding the function of the eye? With out understating how that eye problem impacts the functional vision?  Never! We couldn’t possibly make suggestions for educational programming when we don’t understand the child’s visual skills. How could we ever measure the possible improvements in a child’s visual attention and a child’s visual recognition? How could we ever create appropriate environmental and learning material supports? To not understand or assess these unique issues of brain based visual impairments is to not understand the visual needs of the child.

Doing an ocular assessment only, serves to give false information to the team and false information about the child’s visual skills.

If you are a TVI and you don’t understand how to do a CVI assessment, find out! I am teaching an online class at UMASS Boston about CVI that includes an overview the brain, of assessment of the visual behaviors of CVI and discusses some of today’s promising practices to support students with CVI. To set you on the path in learning, purchase these two books : Vision and the Brain by Dr. Gordon Dutton and Cortical Visual Impairment: An Approach to Assessment and Intervention by Christine Roman-Lantzy.

Blog Response: Littleroom


I really appreciate the questions. Your questions bring up great ideas and topics for blogs!

I received this blog question regarding the Littleroom:

Our colleague wrote: “I would also love your thoughts on the objects placed in the Little Room. How often would you change the objects? Would you move the same objects to different areas of the Littleroom? And do you have a good way to document how a child interacts with the toys, which toys are more often explored, etc?”

My response:

When thinking about providing the child with CVI with a littleroom playspace, I think about my goals. If my goal is listening, touch and activation using compensatory skills, I use a regular littleroom with many objects hung close to the child for accidental activation. As the child begins to know where things are, I raise the objects just a bit at a time to encourage reaching and more distant exploration.

If my goal is looking, I think about the visual environment and use the assessment to make the design:

  • Use bright, single colored objects.
  • Hang things in the littleroom on elastic so they move.
  • The littleroom is a playspace that is created and no one need to hold objects for the child. It allows things to hang in the child’s visual space as long as the child requires.
  • Hang materials in the best visual field.
  • If the child is looking in their best field to an object, I move it to the weaker visual field. Use the favorite toys first.
  • Clutter: cover the top of the littleroom with a white gaze or felt (see picture below) so the child has a great plain background not a complex ceiling with tiles and lights. Toys can make noise in the littleroom and although the child might stop looking, its just fun. There is time to look again.
  • All the materials in a littleroom hang at near!
  • With accommodations for extra response time, best visual field, bright color, movement and the reduction of clutter and provision of spacing, the child has the best chance of reaching.

covered little room005


I keep things the same in the littleroom for as long as a child needs. I think we think kids are bored but children like sameness. (I think of how many times I read the same book to my daughter!)

I will response to the last part of the question tomorrow.




Understanding Faces and Facial Expressions

all the same

Faces are very hard to discriminate!  Look at these faces above.  Are any of the photos the same person???

Changes in hair color, haircut, glasses and even facial expressions completely change the face.

Children with CVI often struggle to discriminate faces and facial expressions.  I will often ask parents to come in to the classroom for a surprise visit.  I ask that they enter quietly.  The child might look and it is clear there is no recognition of this very familiar face.  I ask parents to remain quiet and to move to 12 feet, then 6 feet then 3 feet.  This helps me assess the child’s facial recognition.  When the parent then greets the child verbally, the child lights up to voice and turns to find their much loved parent.

The child might have an easier time discriminating faces at home since there are fewer possibilities (Mom is the only woman who is 5’6″ tall with brown hair.  Dad is the only tall man with a beard).

This is important information to know so we can support children.  One simple strategy is to just introduce yourself.  Children with CVI often find it easy to code by color.  Greetings like “Hi Sue, its Ellen.  I have a green shirt on today” help the child with facial recognition problems find you in the room just by searching first for green.

Reducing Complexity on Surfaces

The child’s learning surfaces are a perfect place to control complexity.  Put yourself in the child’s shoes as you assess the complexity of the environment.  Is there glare, distracting movement, multiple colors in the a background or is there a good solid color background to get a good look at the important learning materials?

  see thru tray

Here is a picture of a clear tray that comes with most wheelchairs.  It is a terrible surface for optimal visual abilities.  The child sees moving legs (movement and multiple colors), the tray produces glare and provides no solid background.

 see thru tray covered

Here is a solid black background that takes care of the problem.  It is made of black plastic and attached with velco.

Reducing Complexity

messy shelf                            shelf covers



The picture on the top is what you find in a typical classroom with materials stacked on crowded shelves.  To reduce complexity, in the bottom picture you see we hung tension rods with black curtains.  In this learning area, children with CVI have the greatest visual supports to learn the essential concepts without struggling to sort the items from complex backgrounds.