Month: July 2014

Highlighted Hands with Red Splints

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If your occupational therapist asks that you get hand splints for your child, order the red ones. The red highlights the child’s own hand, encourages looking to the moving hand target and helps build understanding of the hand as a tool. Kids with CVI miss the very important typical developmental stage of hand watching that all babies do that leads to later hand use. (visual motor characteristic)

Remember to negotiate with the occupational therapist about the exact length of times for splints to be worn. Covering the hands of a child with a visual impairment robs the child of important tactile information. Using splints is important but must be balanced with tactile access needs.

Vision Impacts All Development for Kids with CVI and Other Visual Issues

Cognition

Understanding of Objects/Relationships between objects: child with visual impairments, including CVI, are aware of fewer possible objects in the environment with which to interact. Those that are touched and experienced are often misunderstood with fragmented and limited conceptual understanding. Interactions between objects and events are inaccessible without tactile and auditory support.

Object Permanence: Objects must be tactilely explored to even know of their existence. Object permanence develops later for children with visual impairments including CVI. Without vision, there are just fewer opportunities to build learn this concept.

Cause and Effect: Objects must be touched to create a reaction and the reaction must be tactile or auditory.

Spatial relations: Visual relationships between items are limited. Comparisons of attributes (size, shape, color, relative size etc.) are limited. Positions between and among objects must be explored tactilely and through auditory channels.

Concept development: The child must directly explore real items in the real situations in the real world to gain more complete understanding. Incidental learning is missed and concepts reinforced more often.

Communication: Children lack complete access to the facial expressions, body language, gestures, and referenced pointing, all of which build language concepts. They might have limited or no eye contact to promote social interactions. Children with limited eye contacted are addressed and communicated with less often and for shorter period of time. Because they are listening, they are often described as “good babies”. Because they are quiet, people leave them alone more often. They might have reduced language tied to concepts due to limited object and interaction experience. (dogs, puppies, Collies, Golden Retrievers are all dogs). Pronouns are confused due to lack of a visual reference. Play is often are self focused play (tactile, movement or auditory play) rather than outwardly focused on materials in the world. Children often imitate parts of language heard echoing language.

Gross Motor Development

Children with visual impairments may seem passive and need intervention to purposefully explore and know what there is to explore. The developmental milestones occur with some fragmented sequences (limited lifting head while on the stomach, delayed sitting, standing, and walking). These all benefit from compensatory skills use to build motor skills. (let children crawl to sounds rather than handing toys to them all the time, placing sound making toys up on surfaces to encourage pulling to stand and cruising). With less movement there is often low muscle tone in the truck and arms.  With less experience and without vision there is delayed or poor protective and balancing skills.

Fine Motor Development

Mouthing remains a primary tactile sensory organ for a longer period of time. This is seen as rolling items on the lips and tongue rather than biting items.

With poor experiences using the arms and hands, there is overall weakness. This impacts Braille learning. Tactile defensiveness may develop as people grab their hands to exploration items. The child had no idea what their hands with encounter and they begin to resist this interaction. This lessens reaching to explore. Parents and teachers should use hand under hand exploration to allow children the option of disengaging. Without direct teaching there are delays in activities of daily living such as hair brushing, tooth care etc.

Social-Emotional Development

Bonding is often impacted due to lack of eye contact. Parents and teachers need to look for non-visual cues to a babies needs and interactions. Children are dependent upon parents and teachers to introduce and provide explorations of the environment. Children often have the “good fairy” syndrome.  Things appear and disappear in their world. Overall independent must be supported.

 

Story About Regaining Sight

I think you might find this article very interesting:

http://www.cbsnews.com/news/43-years-blind-man-regains-sight/

This man was visually impaired for 43 years.  He has a typical brain but his brain was denied visual input for many years.  Look at the visual issues he still struggles with after his sight is restored.

  • trouble recognizing things
  • trouble recognizing faces
  • problems with depth and he needs to still use a cane to travel safely
  • visual overload
  • finds color the easiest to visually process

He is displaying many of the characteristics of children with Cortical Visual Impairment in Phase III.  It is important to remember that this man had the benefit of typical vision before the chemical accident that blinded him. Even with the benefit of visual memories (that most children with CVI never have), he remains visually impaired.  His eyes are now fine, but his brain is struggling to understand the visual world.   I would love to hear a followup story and find out what skills have resolved.

Dr. Gordon Dutton Interviews Fiona Lovett

This is a wonderful auditory interview between Dr. Gordon Dutton and Fiona Lovett, the mother of Harry, a child with CVI.  Dr. Dutton shares insights about the effected brain and puts some of Fiona’s comments in a medical context.  The most powerful part of this wonderful interview is the solid understanding this mother has of her child with CVI and the innate adaptations and strategies she’s put into use to help her son see, understand and function in this world.  It’s about 30 minutes long.  Wonderful Scottish accents make it a delight (for me as an American)! Enjoy!

http://www.pplvr.com/news/1948

In my graduate class, I ask my students to listen to this interview and place the mom’s comments about her son into the Christine Roman-Lantzey’s 10 characteristics.  They also record the adaptations mom has put in place.  There are great ideas.

Missing in the discussion is the expectation for improvement for Harry.  This expectation for improvement is central to Dr. Roman-Lantzey’s work.  It is why assessment is so important so we can meet the child at current functioning, chart improvements and adjust interventions and strategies that are no longer needed.

 

Color Highlighting to Support Visual Motor

We want to think about supporting a child’s understanding of where an object is in space and how best to access it with hands or feet.  Here are three examples of color highlighting to support that function:

Where to keep my feet on a balance beam:

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Where to grab my lunchbox:

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Where to grab my family communication book (note red highlighted Braille on the front):

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Where to push to get paper towels:

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When the child is familiar with this activity, the color highlighting is reduced and then eliminated as we see improvements in visual motor skills.

Dr. Gordon Dutton

If anyone ever gets a chance to see Dr. Dutton speak about CVI, it is worth the trip!  He is passionate and engaging.

Here is a link to a website with his CVI Inventories for each age.  He also has some strategies information too.  Remember these are inventories not assessments but still very interesting.

I use these inventories in my graduate classes about CVI to compare Dr. Dutton to Dr. Roman’s concepts.  I cut the statements from the inventories and have folks place them in the 10 characteristics areas mentioned by Dr. Roman.  There is much similarity but they use different words.  By far, most of his statements end up in the Roman area of “Complexity”.

http://biomed.science.ulster.ac.uk/vision/-Visual-skills-inventories,60-.html

 

 

Guiding Principles

I just love Dr. Roman-Lantzy’s Guiding Principles for working with children with CVI!  They highlight professional practice, the need for assessment, the need to have the highest expectation for improvement, the need for precise planning and the ultimate respect for children!

Precision:

  • You must use the CVI assessment to accurately  provide the environmental and learning supports to build visual skills.

Intentionality

  • With assessment you must understand where the student is functioning and where you expect them to function next.  Dr. Roman says not understanding where you are going with your instruction is like a couple of people lost while driving: “Yes, we are lost but we’re making good time”.

Reciprocity

  • Observation is of the ultimate importance. You must respond to the child’s cues.  Put yourself in the child’s shoes and always consider the environment.  When a child is unable to use their vision ask: How is the environment effecting this child’s visual functioning.

Expectation of Change

  • CVI skills improve.  This is a central concept to your teaching.  Assessment must be accurate, interventions must match to the CVI assessment and the environment must support vision use.  As you reassess, make changes to encourage further building of vision skills.

Attention to the Total Environment

  • Complexity of the environment is the major reason that visual skills are poor.  Provide the needed support so the child has access to the instruction at all times.