Reading for a Child with CVI

Please watch these important webinars about teaching reading to children with CVI. Pay especially close attention to the fact that the methods are not uniform. They are in consideration of the visual behaviors of CVI of individual children. No reading approach is for every child. That “visual brain” and that “reading brain” are different in every single child.

The first webinar is by a parent of a child with hemianopsia, Monika Jones of the Brain Recovery Project. Although the webinar is not about reading specifically, there are some important considerations for reading presented. Those reading considerations match the visual abilities of the children with CVI impacted by this brain based visual impairment.

https://www.perkinselearning.org/earn-credits/self-paced/vision-after-occipital-lobectomy-and-related-surgeries

The next two webinars are by Judy Endicott. Judy is the grandmother of a child with CVI. Using her expertise in reading and her building understanding of CVI, Judy embarked on a journey to teach her grandson to read. What I love is that Judy was wonderfully diagnostic of her grandson’s abilities and needs.  Her approach to teaching reading followed her grandson’s lead.  She developed each step in the reading journey based on his successes and difficulties. If something didn’t work, she moved on to try something else in partnership with her grandson. Like any great teacher, she has understanding of the different developmental levels of learning, how the child with a neuro-typical brain learns, and that all learners have individual abilities that require instruction matched to those abilities and needs.

Part 1:

https://www.perkinselearning.org/videos/webinar/our-cvi-literacy-journey-phase-iii

Part 2:

https://www.perkinselearning.org/videos/webinar/our-cvi-literacy-journey-phase-iii-part-2

Mirror Neurons and Incidental Learning

Neuroscientist Vilayanur Ramachandran created this Ted Talk to discuss mirror neurons. Mirror neuron’s role in the brain was recently discovered and research about the function of mirror neurons continues. As Dr. Ramachandran mentions in his talk, he believes mirror neuron use is one of the foundations of human interactions and cultural growth.

Mirror neurons, activated by visual observation, allow us to imitate and practice observed actions and to take the perspective of another person as they operate in the world. I couldn’t help but think of mirror neurons in the context of CVI and visual impairments.

For children with CVI, that lack of essential visual access would make mirror neurons function impossible and this must impact the development of all skills and knowledge, all imitation and the development of all social skills. The role of mirror neurons, it seems, is essentially intertwined with incidental learning and perspective taking, the basis of social skills.

A vast amount of information that a child learns about the world is through this visual incidental learning. If I watch a person eating, I am learning through visual skills alone, how people eat. I know the position for eating, the social skills of eating, and the tools used for eating. My brain, using mirror neurons, is practicing eating long before I ever use a spoon myself. I am exposed to this kind of incidental knowledge all my waking hours from birth and I am learning without being directly instructed.

After watching this Ted Talk, ask yourself these questions:

• Does this not support the need for careful evaluation of what children with CVI really understand and how they understand it?
• Does this not caution us to think about why children with CVI might struggle with imitation and pretend play? (and caution us to be careful to never use this imitation and pretend play criteria for cognitive assessment)
• Does this not justify all direct instruction to students with CVI?
• Does this not justify the repeated need to practice all skills directly taught?
• Does this not justify the Expanded Core Curriculum for students with CVI?
• Does this not justify a TVI who understands visual inaccessibility on a child’s educational team?

https://www.ted.com/talks/vilayanur_ramachandran_the_neurons_that_shaped_civilization?referrer=playlist-how_your_brain_constructs_real

How Often to Assess Learners with CVI?

It has always been best practice in our field of visual impairment to assess children with any visual impairment at least yearly if they have a possibility of changing visual skills.

For kids with ocular impairments (degenerative conditions, damage to the eye or surgeries), sadly this change is usually a reduction in vision. You need the assessment to make sure the materials and methods match the current visual skills to ensure that learning has the optimal visual access.

For kids with CVI, the possibility of visual improvement changes warrant an assessment yearly so the materials and methods match the current visual skill. Waiting for the typical three year re-evaluations might miss a positive vision changes and materials and methods might not match the new visual skills.

Troubling Misuse of Promising Practice

When a new approach to teaching learners with CVI is suggested, we need to ask ourselves:

• Does this match our understanding of the unique learner’s visual behaviors?
• Is there scientific research to support the use of this strategy?
• If there is no scientific research, is it a “promising practice” that we can carefully try and carefully apply to each unique student’s situation?
• How do we decide to use this “promising practice”?
• How do we use it as it was meant to be used?
• How do we evaluate its effectiveness since not all inventions will be useful for all learners? (I hope the words collect data popped into your mind here!)

Recently I visited a school to consult for a student who was barely using any central vision to access literacy. The TVI had learned about word bubbling in a conference. Word bubbling is a promising practice suggested by Christine Roman in her book Cortical Visual Impairment: Advanced Principles.

This TVI took the app for word bubbling and suggested that all the child’s literacy materials were bubbled.

• This does not match the student’s visual skills. Central vision use would be essential for this intervention.
• This is not the suggested practice from the text: Cortical Visual Impairment: Advanced Principles.
• This was randomly applied with no diagnostic evaluation of the tool as applied to the student.
• The TVI never partnered with the reading specialist who would be the expert about the teaching of reading. That collaboration would be essential.
• There was no data on the effectiveness of this strategy for this unique learner.

Here is just one example of a sentence this poor student is now struggling visually recognize. I couldn’t quickly read it and I have good reading skills already developed.

 

Please:

• Understand your student’s visual behaviors.
• Try promising practices with careful consideration of those visual behaviors.
• Use the strategy as it was meant to be used.
• Collect data on the effectiveness of your trial. (Baseline data then progress data)
• Random application of any strategy is as inaccessible as doing nothing..

Are You Making Your Assessment and Service to Learners with CVI Fun?

First and foremost, our children with CVI are children. Children love predictable games, funny noises, and social interactions. Children like to play the same games over and over again. We can get our goals and objectives accomplished with learners if we understand what makes learners happy and what it is that they deeply enjoy. The parent is the most essential reporter of their child’s preferences. We need to move away from what we think children will like to what the parent knows the child will like. That is the basis for faster, fuller and longer lasting learning.

Some ideas, based on assessment of the child’s visual skills:

Instead of holding materials to gain a child’s visual attention and once they look you move on to another object, create a game that sparks a social, auditory and tactile sequence.

• “Find the pom pom. It is silver with many shiny streamers”. Once the child looks, wiggle and tickle their arm while making a funny noise.
• The parent reports that the child likes his/her feet tickled. Present an object that can represent that tickling game. “Here is the symbol for tickling. It is yellow and round like a ball”. Once the child looks, tickle their toes using a funny voice!
• For literacy, pick a predictable book with a distinctive colored cover. Make sure is enjoyed by the child. Once the child looks, “That is the Farm Animal book with funny sounds. The book is square with a green cover”.

Why? All kids are kids no matter their abilities.

• Creating fun, predictable interactions with children is the basis of a strong trusting relationship which allows the child to show you optimal skills in all areas. (Another plug for direct service to students with CVI)
• When interactions and learning are based on what the child likes, the memory of that interaction is solidly stored in the brain.
• Fun interactions guarantee that the child will be motivated to communicate at the highest possible level. (Expanded Core Curriculum area)
• Creating visual recognition using these “symbols” for games allows you to build a repertoire of symbols that will be the basis for choice making based on building visual recognition.
• When you see the way children communicate (large body movements, smiling, raising their arms or vocalizing), you can acknowledge that communication and help the child understand your needs for understanding their communication. “I see a big smile (touch the side of their mouth in an upward motion). When I see that smile I know you want more”. “I see a large body movement. That tells me you like this game”.
• You can build literacy choices and experiences supported by storyboxes, yet another set of visual opportunities. http://www.pathstoliteracy.org/storybox-ideas-norma-drissel
• You will have fun too!

Parent Interview, Observation and Direct Assessment: What is Learned?

 

• The parent interview gives up the across the lifetime visual abilities (improvement history), across environments information (home vs grandmother’s house) and across the day abilities (early in the morning and after a long school day). The parents also identify other visual difficulties for assessment that I might not have considered. Each child has their own unique visual difficulties and the parents help me know what to assess.
• The observations in multiple familiar and unfamiliar environments gives us the child’s functioning in a less adapted learning environment.
• The direct assessment, conducted in a very adapted environment (low complexity, sound, movement etc.) that gives us a look at the visual skills with all the supports in place to support that student’s vision. That direct assessment environment tells us what the child is capable of if the environment is adapted and what adaptations would help.
• We bring those adaptations into the classroom and home for optimal visual functioning and across the day access.

Understanding What is Seen

For students with CVI, understanding what is seen is based on previous knowledge and the expanded understanding of visual attributes

This wonderful example is from Judy Endicott who has a family member with CVI.

Judy shares this experience:

I asked Johnny (now 8), in grade 2 “What do you see?”

Note: (Johnny is not “into” football, and doesn’t recognize the Eagles logo, but Judy is always showing him different newspaper or magazine pictures to gain insight into his visual world, and help him use salient features to identify the image.)

Judy asks: “Johnny, what do you see?

Johnny replies: “A guy in jail.” (Johnny connects the helmet bars with the mistaken salient feature of “jail” that is known to him.)

Judy says: “Point to his head.”  (Johnny does this)

Judy asks “What’s on his head?”

Johnny says: “a helmet” (Johnny understands only part of the image).

 

Then Judy showed him the whole picture:

Judy discussed all  visual attribute information more fully.

She talked about body parts, football, uniforms, etc.

Johnny could label all of the parts correctly when Judy pointed to them, but didn’t connect them initially to help him identify a football player wearing a helmet when Judy initially asked, “What do you see?”

The type of questioning that Judy used: “What do you see?”  insured that Johnny truly had access to the visual images and concepts. When it was clear that he truly didn’t have access, Judy knew this was the critical place for more instruction.

Phase I: Visual Affects

The child in Phase I may act like a child with total blindness. They might not locate or visually attend to much in their environment. This is not due to visual acuity but to the overwhelming complexity of the environment. They just can’t handle the confusing swirl of kaleidoscopic color and movement.  Because they behave as if they are ocularly blind, they are treated as ocularly blind. Their vision is never considered, assessed or programmed for. With this lack of visual challenge, they go on to develop auditory and tactile compensatory skills and visual skills lag behind.

One student I assessed in the past at age 11, acted in such a way. She felt for objects rather than looking for them. Once assessed using the CVI Range (Roman-Lantzy 2007), it was clear that presented with materials, given 20+ seconds, on the left visual field at eye level, with bright saturated colors against a non-complex background, this student did, indeed have useable vision. The educational team was present for the assessment and films shared with her parents. From that day forward, visual skills were considered, visual expectations appeared on her IEP, and visual skills improved even in two short weeks. She gained the gift of visual access!

Functional visual assessment using the CVI Range would have identified this sooner. She had only ever had an ocular functional visual assessment even though there was nothing wrong with this student’s eyes. The wrong assessment tool led to the wrong conclusion.

When you act visual impaired and are not assessed using the correct assessment tool, you will never gain visual access..

Scoring the CVI Range Reliability Workshop

This face to face workshop with Dr. Sandra Newcomb is a wonderful and rare opportunity for parents and professionals to practice assessment using the CVI Range (Christine Roman-Lantzy)

The bedrock of service to students with CVI is the accurate assessment of their functional vision using the CVI Range.

This workshop will be held at Perkins School for the Blind in Watertown, Massachusetts on November 3rd and 4th, 2017.

I know when I was learning about CVI, the hands-on practice with other professionals increased my assessment skills and therefore improved the reliability of the results of that assessment of my student’s functional vision. I could be confident that I was scoring it correctly, identifying the correct needs and then providing the correct interventions.

The What’s the Complexity Framework: Designing a Visually Accessible School Day for the Child with CVI

This is an online CVI related class through Perkins elearning conducted by Matt Tietjen.

October 23^rd to December 10^th, 2017

It provides educators with 35 ACVREPs, 35 PDPs, 35 CEs, or 3 Graduate Credits

Matt is a passionate and gifted practitioner serving students with CVI in all Phases (Roman-Lantzy). He recently developed this framework to help teachers, TVIs, therapists and parents assess the complexity of visual presentations, learning activities and learning environments for students with CVI. I signed up to learn more about this important new tool for my work with students.

Here it the description:

“We will study the characteristic “Difficulty with Visual Complexity” in-depth, explore its central relationship to the other characteristics, and examine the ways in which it can impact behavior and access to education for a child with CVI. Our study of visual complexity will integrate the literature on cortical and cerebral visual impairment.

Participants will learn how to use The What’s the Complexity Framework in order to evaluate the complexity of school environments, tasks and materials and to guide educational teams in creating more visually accessible, appropriate learning activities for children with CVI.

In addition to learning how to rate the complexity level of a particular environment or education task, we will also emphasize the importance of balancing the complexity of the environment and task in each activity, managing cumulative complexity and visual fatigue throughout the school day, assessing interpretation of two-dimensional images, and providing direct instruction in salient features.”

http://www.perkinselearning.org/earn-credits/online-class/cvi-complexity