Month: June 2016

Youtube Lecture: Recovered Sight: Michael May

Understanding Blindness and the Brain (Brian Wandell, Stanford University)

I think you might find this one fascinating! Michael May lost vision as a child and regained it in his 40s. As he regains sight, there are so many CVI characteristics he experiences!

https://www.youtube.com/watch?v=VVgfC_FV2hI

Connecting Vision and Compensatory Skills

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For my student, the personal identifier needs to be visually accessed on his left side, slightly above eye level.

I chose the red, furry fabric as his 3D personal identifier after his CVI assessment. The personal identifier is attached with Velcro so it can be removed and moved closer to this child. I can create movement to draw his visual attention. This student looks most reliably at the color red, to movement against a non-complex background, to materials within 12-18” and I know, from assessment, that he can’t access flat 2D pictures or icons. This personal identifier appears on all of this student’s belongings and locations (ADL box, locker, calendar system, etc.).

To approach his locker, he is positioned so the lockers appear on his better left side. Two identical personal identifiers are placed on his locker, one at eye level for visual access and one lower for tactile access as he trails the lockers with his left hand. Over time, this student is observed visually searching to the left on his locker after he encounters the tactile symbol. This visual and compensatory skills access supports his visual location, his anticipation of what he will see and connects sensory concepts.

“She Sees When She Wants To”

I wish I had a nickel for all the times I’ve heard this comment about children with CVI: “She sees when she wants to.” I would be a rich woman!

Looking is not a choice.  Shown any item, we with typical vision, need to look at things in our world to decide whether we want to interact with it or not. We can decide to grab it, eat it, throw it or ignore it but we must look to determine what it is first!

So why do our children with CVI seem to see some things and not others? Why do they have this inconsistent visual regard to materials in their environment?

I find my students look and look and reach most consistently with those materials that are familiar. These are the materials that my students have formed a strong visual memory of. Its firmly in their visual library. Looking at it and recognizing it are solid skills.

My student, Judy, lacks visual attention for most materials in her environment. She requires the strictest environmental controls for visual location and for sustaining her vision to most materials. Judy does love Goldfish crackers and water bottles. She can find a goldfish cracker on her tray immediately, reach to it and gobble it up. She can spy a water bottle 6 feet away, smile in recognition and cross the room to grab it. She shows no other visual recognition to any item at this 6 feet distance except light.

People who do not understand CVI or understand how important familiar materials are to children with CVI, misinterpret this as a “behavior”. They blame the child for lack of interest. Seeing this ability in the context of the CVI, is the only way to interpret this ability and to expand a student’s access to the world with lateral learning.

Using Backlighting for Calendar System

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This student with CVI came to our program with a calendar system. The problem was that she wasn’t looking at the photographs or icons at all!  We enlarged the icons and made them translucent. We presented all icons for her calendar system on the lightbox. We standardized our verbal visual attribute language for each presentation so that each icon was described exactly the same by all staff. The student immediately visually located the icon against the backlighting and sustained gaze during the visual attribute language descriptions. This student now has visual access supported by auditory information to build understanding.

(The photograph is modified to protect this student’s identity.)

Testing Visual Display Threshold

It is very important to determine the exact number of items in a presentation that a child can look at and recognize.  I need to always be sure a child can discriminate one item from others as a visual skill before I use larger arrays for teaching. To begin to assess this, I use that child’s very favorite item in a decreasing number of dissimilar items.  I present that favorite item in an display of 6 items, then 5 items, then 4 items, then 3 items and finally 2 items until I see the child look towards and recognize their favorite. I conduct this assessment over a series of days, taking data on the attributes of the presented items (in the same environment), the number of items and the time the child needed to find their favorite one. If they have the ability to reach, I look at the quality of reaching (direct reach while looking, direct reach while looking away, sweeping reach while looking or sweeping reach while looking away).  Once I have data about the child’s abilities with increasing displays, I can make recommendations to the team about the number of items that can be visually tolerated for recognition to occur.

Finally, I would want to test this display tolerance with items that are similar to one another as well but if I am testing this at all, it means I am concerned about this tolerance of array.  The recommendation for dissimilar materials is always in place for ease of discrimination in all situations with all alert states and in all environments.

Throughout this testing, I use dissimilar materials; all different from one another in color, shape and size. Recommendations to the team must include a suggestion for any array, especially with symbol systems, to highlight the need for items used to be of great dissimilarity.