Month: August 2014

2D Considerations




IMG_0504            IMG_0503


When I lecture about CVI and the use of 2D images for communication, I often show these line drawings that are so often chosen as symbols for kids.  The images are partial and highly symbolic.  The only way I understand what the drawing means is because I have  intact visual memory and cognitive abilities to make the fantastic leap in understanding what this picture is referencing.  (Even with that visual memory and cognitive abilities, it takes me a while to figure out what this picture represents!)

People choose these types of 2D images for kids who are not even looking or not looking long enough to access the image at all.

Children must have any 2D symbol use built on solid understanding of the real 3D before the symbol is at all useful.  We must be very careful using symbols that children can not access.  It is easy to confuse lack of understanding of pictures with cognitive or language issues when they are real lack of access to the image in the first place.

Looking does not mean understanding.  Holding pictures in front of kids does not mean they are looking long enough to interpret it.

Calendar Systems

This is a wonderful handout done by a colleague and friend.  Great 3D object calendar system with adaptations for children with CVI (low complexity, single items at a time with added two items when the chid is ready, latency, familiarity and visual motor)!


CASE Collaborative – Preschool and Primary Programs

Using an Object Schedule in the School Setting

By Tess Daigle, Speech and Language therapist CASE Collaborative

Adapted from “What’s a Calendar Box?” by P. Schachter, Calif. Deaf-Blind Services and Dr. C. Van Dijk


An object schedule, also sometimes called a schedule book or calendar box, uses object symbols to represent activities in a day or within an activity. Objects to be used for the schedule are selected carefully. Each one is an item that is closely associated with a particular activity ( e.g. washcloth = bath time) and that is meaningful to the child. An object schedule supports a child’s participation in the events that make up his life, support his understanding of what is going to happen, and help him anticipate upcoming events. By knowing what is going to happen next, a child can feel more in control and more independent.


  • An object schedule provides structure to the time and some order during the school day.
  • The object schedule routine includes the “all done” bin to signal when an activity is finished.
  • For a student with dual sensory impairment or multiple disabilities, using an object schedule allows him to understand what he is going to do now, then what he will do after that, etc. This, in turn, helps him to better understand the structure of the day and gives him a sense of predictability in his life.
  • Through repetition and experience using the object schedule daily, a child learns the meaning of the object as a symbolic representation of a span of time and it provides information to increase a child’s receptive knowledge of events and routines in the school day.
  • A schedule helps a child remain calm and reduces stress during transitions
  • Consistently accessing a schedule may increase a child’s flexibility

Selection of object symbols:

  • Children understand real objects before they understand representations of them such as pictures, printed words or Braille.
  • An object is selected to represent or symbolize a space in time or an event.
  • Objects should be easy for the child to associate with the activity by sight, sound or touch. Consider how it feels, looks and sounds to do an activity from a child’s perspective, not yours. For example, if you are selecting a cue to tell a child that she will be placed in her wheelchair or stroller to go home, look at her when she is in her chair and observe where her hands typically rest. A piece of fabric, a buckle or metal that feels the same will likely be a meaningful cue for the student. A dollhouse wheel chair, while a very concrete symbol for us, will not look or feel at all like a wheelchair to the student.
  • For a child with visual impairment, an object provides important tactile information to support her participation in routines.
  • When selecting a symbol to represent an activity, such as taking a bath, think about what symbol is meaningful to the child. Some activities are not practical to represent with the most significant feature; for instance, using water to represent bath time. A faucet may not have meaning to her unless she enjoys helping turn on the bath water. Instead, a favorite bath toy or a washcloth may be more motivating to her and help her make the association between the object and the act of going upstairs to take a bath. *
  • You may need to add an object to the routine to help provide an object cue. Consider incorporating an object into a routine within an activity to reinforce its meaning (e.g. shaker egg (cognitive work) – at the start of the session, the child shakes the egg and drops it into a container. The cognitive work session could also include placing other objects or shakers in a container.)
  • Keep in mind that your object cues may be lost, thrown in the trash, or otherwise destroyed. Make sure you choose something that can easily be replaced and always have extra objects on hand.
  • Try to select objects that can be cleaned and sanitized to avoid passing germs within the classroom.
  • Objects should be small enough for a child to hold in one hand, but not too small that they are easily lost or swallowed.

Organizing/ Setting up a child’s daily schedule:

  • When a child is using more than one object cue, a calendar strip, book or boxes will help organize and sequence the day’s activities. Even just two different objects can be organized to help the child know what is going to happen now and what will happen next.
  • Students in the CASE Preschool and Primary Programs use a schedule book with one object symbol on each page to represent an activity within the school day. The book is portable, light weight and can be easily transported on a child’s chair or positioning equipment.
  • The child’s schedule book “travels” with him throughout her school day, often hung on the back of the child’s chair or walker. An easy rule of thumb – if you see the child, you see his schedule book.
  • If there are not enough pages in the child’s schedule book for every event in the day, the schedule can be set up for the morning routine, then reset for afternoon routine.
  • An “all done” bin is placed in a consistent location (often to the right of the child). An object symbol is placed in the “all done” bin when an activity is completed.

How to begin:

  • Guide the child to his personal schedule book. The child’s schedule book may be identified by his name in print, braille, and/or by his personal identifier. Assist him to open the book, reach, grasp, look at and examine the object on the page (Mouthing is fine too, if it is not a behavior that you are trying to stop.) Give the child enough time to thoroughly examine the object.
  • Here is Tim’s calendar system with his red shiny strip of mylar as his personal identifier.


  • Tell him with a few words, signs or both, what is about to happen.
  • Assist the child to grasp the object and take the object with him to the place or activity it represents. If appropriate, guide the child to “match” the schedule object with an identical object located in the area where the activity will take place.
  • Tim has two activities pictured here, bathroom then PT.

 third page

  • When the activity is completed, say or sign “finished” or “all done” and guide the child to place the schedule object in the “all done” bin.

highlighted bin 030

  • **NOTE** Completing the cycle of getting an object out from the schedule book, moving to the location and engaging in the activity, then putting it in the “all done” bin is really critical. Many children with dual sensory impairment have no concept of the beginning or the end of objects or activities. With limited sight and hearing, everything just appears, almost magically and disappears the same way. Consistent use of object schedules assists children to anticipate what is going to happen next and to understand that events have a start and a finish. These are important concepts to develop; they provide the child with a sense of control over his environment.

Problem Solving:

  • Naturally, these techniques will not always work so easily in your classroom. A child may throw objects, tear them or scream when you guide him to reach into his schedule book. In these instances, you may need to:
    • choose more indestructible objects
    • Move more slowly in guiding a child to hold or reach
    • Choose items that are not over stimulating to the child with tactile defensiveness
    • Consistently guide a child even when it seems that you are doing all the work and the child is passively receiving your input.
  • It may take many months or even years of consistently telling the child what is about to happen before you see a noticeable response. Think of this as “listening” time, taking in what you are “saying” and building receptive knowledge of the world. All children deserve to be told what is happening to them in a way that they can understand, even if they don’t tell us anything back

What are we looking for?

You will know that the objects from the object schedule are gaining meaning by closely watching the child’s behavior. A smile when feeling the object, a relaxing muscle tone, a purposeful reach or visual glance toward the place or the activity that is happening, and searching for the schedule book and searching for an object, are just a few of the possible behaviors that will tell you that a connection is being made. In addition, a child may express what he would like to do next or he may use the symbols to have a conversation with you about his day.

Object communication and object schedules can be powerful communication tools for a child with dual sensory impairment or multiple disabilities. They may also be new and confusing method of communication for a teacher, parent or therapist. Don’t hesitate to ask questions or to share your ideas about object schedules that our children are using. Collaboration and consistency will lead to every child’s success!


Touch Cues

Touch cues are receptive communication cues that are very important for all children with visual loss. Children with CVI benefit from touch cues for greetings and before touching or moving their bodies. Consistent touch cues allow the child to anticipate what is happening next and who is touching them. Using touch cues reduces anxiety and increases the child’s sense of control over the world.

The touch cues are given directly to the part of the child’s body that will be touched or moved.

  • Touch to the foot before moving it to put on a sock or shoe.
  • Touch to the chin before giving the bottle.
  • Touch to the arm before moving it to place in a sleeve.

Using consistent person identifier touch allows the child to understand who is interacting with them

  • Dad always holds my knee when greeting me.
  • Mom always strokes my upper arm when she greets me.


Touch cues can be directional:

  • Pushing slightly in the direction of the roll before rolling them over on their side.
  • Stroking down the sides of the head before pulling the shirt down over the head.
  • Stroking both legs downwards before pulling down the pants.


As the child becomes familiar with a touch cue, give the cue and wait slightly. Does the child raise the leg that the cue indicated? This is wonderful expressive communication and tells us much about the child’s understanding of the touch cue and ability to anticipate.

Touch cues can be developed by anyone but must be consistently used by all for optimal understanding.

Evaluate Pictures for Clarity and Perspective

bad contrast hat

When the child with CVI is ready for images, we need to make sure the picture is clear and represents as close to a real perspective as possible.  The above picture of a construction hat is clear but the background provides no contrast and is distracting.  The glare from the overhead light is a problem and the perspective is confusing.  Our brains with perfect vision can understand this is a hat.  Children with CVI do not have the benefit of the visual memory that supports this understanding.

good cvi picture hat

This picture is so much clearer with much better information for the child with CVI.  Supported by seeing this exact same hat in a story box, the child with CVI can build a visual memory and build 2D understanding of this image.

No high tech equipment was needed for this picture.  I covered a tissue box placed up on its end with my black sweater.  I placed a black background behind it.  I used my iPhone to take the photograph.

The shift from 3D real items to 2D images needs to be carefully support by pairing with the exact same real object and presenting clear photographs.