Month: March 2015

Distance Shiny Target: Bowling!


This idea comes from TVI Janet Johnson. Janet took the idea of presenting a distance shiny target and created bowling game using juice cans and a large ball. Her student with CVI has always loved to throw things to hear an auditory event. Now the student uses her vision to see the shiny target before she rolls the ball. She loves the crash, boom and bang of the tin cans going over!

Thanks Janet!

Light: Friend and Enemy

Lightgazing can be such a strong feature for children in the early phases for CVI.

With the skills of children with a greater impact of CVI, we struggle to gain a child’s visual attention to a more meaningful visual targets. We need to control all light sources from overhead and from surrounding doors and windows. We also recognize that placing meaningful visual targets against Lightboxes, iPads and other backlighted surfaces can support that more meaningful gaze to objects. We understand that lighting objects and lighted objects will more easily gain attention, the first skill for visual learning.

As visual attention improves, children can break their attention to light to look at meaningful materials and light remains a valuable tool to gain attention and increase the length of looking. We still need to control overhead and outdoor light sources for the best visual attention.

As visual recognition improves,backlighting helps some children’s understanding of 2D materials: letters, numbers and pictures and reduced their visual fatigue.

All children’s reactions to light are part of any assessment of their CVI.

MRI: No measure of CVI

Like it or not, CVI cannot be diagnosed with a medical test.  I sure wish it could be!

The MRI can be completely normal and the child can still have CVI.

The MRI can show huge brain structure changes and the child does not have CVI.

The MRI only sees changes in structure NOT visual functioning. It cannot diagnose CVI.

CVI cannot be diagnosed medically with any available medical test.

Another condition that cannot be diagnosed medically is autism. Both CVI and autism are diagnosed by looking at behaviors.

Good doctors see these behaviors, ask parents about these behaviors and diagnose CVI or autism.

It is great to get a diagnosis from the doctor for CVI but for assessment of visual skills, assessment of the brain based visual skills it the only criteria for assessment. With the complete assessment, you have accurate information for creating environments and optimal educational programming to help foster possible vision improvement.

Strategies for Visual Access in the Car

Riding in a car is something most of us do regularly. We want the child with CVI to have visual opportunities during this time. Here are some strategies to provide this visual access:

  • Light is coming through the window on the side of the child. This light and motion often draws a child’s visual attention. Lightgazing is a primitive, early visual skill. To encourage more purposeful vision use, hang a visual target on the window. That visual target is now backlighted by the light coming from the window. Making sure this target moves (slinky, things hung by elastic, or perhaps beads) capitalizes on the child’s possible need for movement and light. Also remember shiny objects simulates movement because they are reflective so these materials would also be useful here.
  • Most children are seated on the passenger side where the motion and light draw attention to the child’s right visual field. Shake it up and place the child on the left side of the backseat. Now the movement and light (with added interesting visual target) are coming from the left side to challenge that visual field.
  • Create a black background using a black cloth hung on the seat in front of the child. Hang visual targets from this new active visual learning opportunity. The cloth can drape from the seatback to the child’s lap. Attaching a soft hair scrunchie on the child’s wrist will create an opportunity for the child to see movement they  control. I have had great success attaching slinkys or beads to this backdrop and to the child’s wrist. How powerful for the child to see movement they created!

Please remember every strategy is developed after assessment. The goal is to provide visual opportunities matched to visual need. You will only understand that visual need after assessment.

Cortical/Cerebral Visual Impairment vs. Delayed Visual Maturation

Many children with Cortical/Cerebral Visual Impairment (CVI) are diagnosed with Delayed Visual Maturation (DVM). The doctor tells the concerned parents to wait and see…

We cannot know which condition, Delayed Visual Maturation or Cortical/Cerebral Visual Impairment is affecting the child but this first year is a precious year of brain development including vision development that should not be wasted.

If an infant is not using vision, assessment of visual skills and placing visual strategies in place is important whether the child has CVI or delayed visual maturation. We have nothing to lose and all to gain by creating environments to support visual development.

Delayed Visual Maturation always resolves in the first year so certainly this cannot be used as a diagnosis after the infant’s first birthday. If the child is over the age of one, this is a child with CVI.

 Definitions from American Association for Pediatric Ophthalmology and Strabismus

What is Cortical/Cerebral Visual Impairment?

Cortical/Cerebral Visual Impairment (CVI) is a decreased visual response due to a neurological problem affecting the visual parts of the brain. Typically, a child with CVI has a normal eye exam or has an eye condition that cannot account for the abnormal visual behavior. It is one of the most frequent causes of visual impairment in children from developed countries.

What is delayed visual maturation (DVM)?

Delayed visual maturation is similar to Cortical/Cerebral Visual Impairment in that an infant has a normal eye exam but does not demonstrate typical visual behavior.  Unlike CVI, the visual response improves in a child with delayed visual maturation and resolves by one year of life.