Assessment

What Do iPads Support for Students in Phase III

As discussed many, many times, the strategies for CVI must match the assessment results using the CVI Range (Roman-Lantzy 2007). We never can just randomly apply a strategy because it will not fit the functional visual needs of the child. If it does not fit the functional visual needs, it will not provide visual access and will not foster improvement of cognitive and visual skills.

With that reminder, I was asked about ideas for iPad apps for children in Phase III (Roman-Lantzy). Just providing a student with an iPad does not guarantee access. We need to assess the child, think about their visual needs and carefully use the iPad as a tool to provide that access.

What can be some general needs for students in Phase III?

Color: The student might benefit from color highlighting to draw visual attention to salient features of pictures and text. (Roman-Lantzy)

Light: Backlighting helps foster access to materials especially in 2D (pictures and text).

Latency: There is still a need for increased time for full visual exploration and full visual understanding.

Visual Field: Lower visual fields might be affected.

Visual Novelty: Presenting novel materials might requires salient feature and comparative exploration. (Roman-Lantzy)

Complexity: Complexity affects visual understanding in objects, increased arrays, of faces, and of the sensory environment.

Distance: Near information is more accessible. Distance curiosity is not typical so distance information is missed.

 

How do we want the iPad to support the student in Phase III based on assessed need?

Color:

  • Tools for color highlighting help support salient feature discussion in pictures and text.

Light:

  • Backlighting helps with understanding and easy of access to prevent fatigue.
  • Moving to 2D: taking pictures of their items in the environment and then providing the 2D on the backlighted iPad.

Latency:

  • Provides ability to capture images and videos for longer visual access time.
  • Capturing images can be reviewed as long as needed.

Visual Field:

  • iPad placement is flexible matched to child’s best visual field.

Visual Novelty:

  • Expanded understanding: Example: Here is one kind of mouse in the book but these are all the other kinds of mice.

Complexity:

  • Enlargement: for things at distance, for small items in complexity and for literacy
  • Overall ability to use settings and apps to reduce complexity of images.
  • Studying facial expression in photographs and videos: salient language of faces matched to voice (auditory). There can be instruction about facial expressions that match the auditory information.
  • Salient feature discussion in photographs and text.
  • Increasing spacing of words and sentences to reduce complexity of array.
  • Masking: complexity reduction with tools in Photos.

Distance:

  • Videos on the iPad: to bring information about events and concepts that occur at distance: Example: We are reading about giraffes. I think about providing a child with access to where that animal might live and how they move.
  • Access to distance classroom events: Examples: learning song hand movements for circle time.
  • Community access: taking photographs of signs and environmental materials that can be explored on the backlighted, near placed iPad.

The Expanded Core Curriculum (ECC) for Students with CVI

What is an Expanded Core Curriculum?

Years ago, students with visual impairments were educated in separate schools for the blind. Curriculum needs addressed everything for the student with a visual impairment both academic areas and specialized instruction that provided students with all skills to insure full independence in life. Students often lived at the school and instruction occurred across the day: self-care, moving safely in the environment, using transportation, safety awareness, social skills and recreation opportunities were embedded.

The education model shifted in the 1980s and students with visual impairments increasingly moved to inclusive programs in their communities. These inclusive programs could address the academic needs of students with visual impairments when adapted by a teacher of students with visual impairments. Something was missing. At the inclusive setting, inclusive schools were unprepared to address the other important learning needs for children with visual impairments. They never had to address these important areas because students without vision loss learn these skills incidentally by watching.

The Expand Core Curriculum is an essential consideration for all children with visual impairments including children with CVI. The nine areas of the Expanded Core Curriculum, if they are considered at all, are often mistakenly considered only for the academic child with ocular visual impairments.

Inclusive school settings teach the general education curriculum of math, science, English language arts, foreign language, gym, science, social studies and fine arts to their students. For students with visual impairments, the expanded core curriculum provides those essential independence skills needed for living and working. The expanded core curriculum is meant to level the educational playing field by providing instruction specific to the needs of a child with a visual impairment.

The expanded core curriculum, or ECC, should be used as a framework for first assessing students with visual impairments, then for planning individual goals and objectives.

The nine ECC areas that provide this specific instruction include.

  • Compensatory or functional academic skills, including communication modes
  • Orientation and mobility
  • Social interaction skills
  • Independent living skills
  • Recreation and leisure skills
  • Career education
  • Use of assistive technology
  • Sensory efficiency skills
  • Self-determination

Are these considered on your child’s IEP? We will look at each a bit more in-depth in later posts.

“Duckness: How Do We Know?

Look at this series of pictures. (From American Printing House for the Blind website)

How can very young children with intact visual skills understand that these are all ducks?

They understand “Duckness”.

They have a keen understanding of the salient features (Roman-Lantzy literacy) that make up this “Duckness” because of shared visual experiences with others and with access to pictures, TV and movies that feature ducks. This develops effortlessly for children with intact visual skills.  Without direct instruction, they understand that real ducks are different sizes, colors, and ages. They understand that ducks can be seen in different perspectives depending on where and how they are standing. They understand that ducks can be flat in pictures. They understand that ducks can be symbolic in toys, signs, pictures, colored cartoons and in black and white drawings.

Our children with CVI lack this visual access to “duckness”. They lack the expanded and repeated knowledge about ducks. If they have seen a duck, their idea of “duckness” is limited to that one duck. Due to reduced eye contact with people and with reduced eye to object abilities, adults do not explain the shared salient features that all ducks share.

As adults serving children with CVI, we should be aware of this limited access and limited understanding that can occur in 3D and 2D. We must create opportunities to expand children’s access matched to their assessed functional visual skills measured with the CVI Range (Roman-Lantzy 2007). We must evaluate all our materials with this visual access limitation considered. We must adjust our own interactions and instructions to include salient feature, comparative language (Roman-Lantzy).

How Do You Know If You Have a CVI Competent Teacher of Students with Visual Impairments? Importance of the Perkins-Roman CVI Range Endorsement

How would parents, teachers and administrators know if they have a teacher of students with visual impairments (TVI) who is knowledgeable and competent to work with children with CVI? This has been huge and frustrating problem for years.

TVIs have been slow to educate themselves to serve these students with CVI effectively even when their caseloads have shifted to include many students with CVI. TVIs might attend a lecture or two and mistakenly think they have “competency” in CVI. The TVI who attends a weekend lecture about CVI, leaves with partial knowledge and few abilities to accurately assess, accurately program or to accurately create appropriate interventions for their students with CVI. They are even more dangerous than the TVI with no understanding!

Most graduate teacher training programs for teachers of students with visual impairments do not include CVI as a core competency area. Due to this, even now, new teachers of students with visual impairments leave graduate programs with little to no understanding of CVI yet take jobs in the field where 60% or more of the students have CVI!

To solve the problem of who has CVI competence and who does not have have CVI competence there is now the Perkins-Roman CVI Range Endorsement in place at Perkins School for the Blind: http://www.perkinselearning.org/cvi-endorsement

For this Perkins-Roman CVI Range Endorsement, a teacher of students with visual impairments must prove their competency for CVI. They must take a knowledge test about CVI. They must prove experience with students with CVI by providing letters of recommendation. They must prove their ability to assess 2 students seen in videos using the Christine Roman-Lantzy CVI Range. The CVI Range is the only assessment tool for CVI with reliability. (See Dr. Sandra Newcomb: Reliability of the CVI Range Journal of Visual Impairment & Blindness, October 2010, © 2010 AFB).

We now have a way to “check” a professional’s competence in a directory of endorsed professionals: http://www.perkinselearning.org/cvi-endorsement/specialists?field_location_taxonomize_terms_tid=All&field_name_address_country=All&page=2

I always want a competent professional to work with my students with CVI and now add this statement to my report recommendation list:

Recommendations:

Services of a Certified Teacher of Students with Visual Impairment (CTVI) who is CVI Endorsed:

John will benefit from direct and consult vision services weekly from a certified vision professional who understands CVI.  To assure this competence the TVI must be CVI Endorsed: See the Perkins-Roman CVI Range Endorsement http://www.perkinselearning.org/cvi-endorsement Look in the search bar to access the directory of endorsed professionals: “Search for Specialist”. This will assure that the assigned TVI understands CVI, understands the effects CVI have on John’s learning and is trained to assess CVI using the Christine Roman-Lantzy CVI Range. John will benefit from environmental and materials modifications, methodologies and accommodations to support his visual functioning around all characteristics of CVI. The TVI will help build compensatory skills throughout the curriculum and support building advocacy for John’s independent learning. Every year at change of classroom, the TVI should provide an overview of the concept of CVI and provide a detailed explanation of how CVI effects John’s visual functioning.

To find endorsed professionals, you can visit the directory of professionals that have achieved this competence. It is growing daily nationally and internationally.

 

Adapting Classrooms for Children with CVI

It can be a real challenge to adapt learning environments for our students with CVI. Of course, one adaptation suggestion is never the answer. The environment must match the child’s assessed functional needs around CVI. The functional visual assessment for children with CVI must be the CVI Range (Roman-Lantzy 2007). Even children in the same Phase of CVI, must have distinctly unique adaptions for their environments and for their learning. These distinct needs can only be identified with assessment of the individual child.

For a child with an ocular impairment like retinopathy of prematurity (ROP), we would never say “Oh, this child has ROP? Here are the environmental needs and the learning material needs.” We would assess functional vision to identify the unique visual needs of that individual child. Our children with CVI deserve the same respectful and accurate assessment of their functional vision. They deserve accurate environmental supports and adaptations to learning that match that assessment.

In several classrooms where I serve children, the reduction of visual and auditory complexity and controlling access to light are the most challenging environmental adaptations. The solution we have used was to create learning centers in the classroom using cubicles.

 

These cubicles were donated by a business that was renovating their offices. The donation was a free and effective environmental support for many of my students. The cubicle walls are large and sound reducing. They tend to be tall which blocks distracting light. Perfect for so many children. Call your local Chamber of Commence or contact your local Rotary Club. I’m sure businesses would be so happy to help and to see these cubicles recycled and put to good use!

What’s the Complexity? Workshop

This month I attended a full day workshop titled: “What’s the Complexity?” with creator, Matt Tietjen, M.Ed. CTVI. This assessment tool was developed to look at the characteristic of complexity as described in the work of Christine Roman-Lantzy in the CVI Range 2007.

The “What’s the Complexity?” framework takes a close look at the characteristic, Complexity,  that is most difficult to control and the characteristic that seems to effect children’s visual functioning to the greatest degree. It provides a way for parents and educational teams to assess complexity in all forms. It helps parents and teams choose appropriate materials, design appropriate environments matched to appropriate tasks and then to plan across the complete learning day for the student with CVI.

It focuses on all Phases of CVI (Christine Roman-Lantzy) but I believe is most valuable for the students functioning in Phase II and Phase III as they try to access pictures. The “What’s the Complexity?” framework also provides us with a well thought out system to assess the student’s interpretation of images. We evaluate the child’s understanding of photographs of their real items (my spoon), colored photographs of other classes of items (the class of spoons), understanding of realistic or abstract cartoon icons of items (spoons in cartoon form), colored icons (Mayer Johnson spoon) and black and white line drawings (black and white drawing of a spoon).

This is an important new tool for us as we serve our children with CVI. It will help support our recommendations for children’s accessible media. Fantastic!

I understand that a graduate class will be offered in September at Perkins elearning to deepen the understanding for using the “What’s the Complexity?” framework. I will certainly be signing up for this!

 

Morning Meeting Ideas for Children in Phase I

I had a request for some morning meeting ideas for children in Phase I as measured on the CVI Range (Christine Roman-Lantzy 2007). The concepts and vocabulary around “Characteristics” and “Phases” come from Dr. Roman-Lantzy’s work.

The first place to start, of course, is to assess the child using the CVI Range. This is the only functional vision assessment for children with CVI. Understanding the child’s functional visual skills allows you to create goals and objectives and to provide across-the-day accommodations and methodologies to meet those needs.

Phase I:  Goal: Building Visual Behaviors. Providing access to use visual skills around the 10 characteristics.

The child has a favorite color and will only look at simple one colored items. (Color)

  • Materials in morning meeting must meet the color preference. This is not always red o yellow. Your assessment will tell you the preferred color. Because this child is very visually impaired, compensatory skills should also be considered. Items presented must be 3D, real objects NOT PICTURES! 3D objects will provide visual access, tactile input, olfactory input and auditory input.

Pictures are completely inaccessible for this child who is not using central vision   effectively. (Central vision is essential for children to understand any 2D materials).

The child looks at movement or shiny items but does not seem interested in stable objects. (Movement)

  • Materials in morning meeting must meet this assessed need for movement of the presented materials to foster visual use. Shiny items are considered under the Movement characteristic since the reflected light from the surface looks like movement. Movement should be gentle and slow not fast and frantic.

There is no or little reaction to visual threat or touch between the eyes. (Visual Reflexive Responses)

  • Reflexes are reflexes and cannot be taught. There are no accommodations for visual reflexes.

The child fixates briefly but likes light, ceiling fans and movement. (Light gazing and Movement)

  • To foster looking at the presented morning meeting materials, light must be controlled, limiting the child’s lightgazing.
  • Because light is important to encourage looking, light the materials that are presented or use materials that light up.
  • Because fixation is brief, the material must be presented for longer so the child has another opportunity to visually locate.

The child sees things in the peripheral fields but does not react to items in central vision positions. (Visual Fields)

  • Because peripheral fields are stronger than central visual fields, the materials must be presented off center in the best assessed lateral visual field. (The child in Phase I will have a distinct preference for one lateral visual field).
  • The lower visual fields are often not functional well into Phase III so eye level is recommended. Upper fields can also be inaccessible.
  • Make sure the “action” of morning meeting is within their best assessed visual field.

There is visual attention in near space only within 2 feet. (Distance and Complexity)

  • The child can only look at items in near space. The exact assessed distance needs to be respected and materials presented within this distance. At this Phase, this is typically within 18”-24” of the child’s eyes.
  • Give the child a copy of the material being used with other child in turn. This provides visual access for the child even when materials are being presented to other children at greater distances.

The child rarely looks to faces (Complexity).

  • Faces are very complex. This child will have difficulty looking at faces. Be mindful that the child may be attending but not able to make eye contact or even look towards your face if you are talking. Greet them with your name and tell them what you will be doing with them. Call their name before delivering a message or asking a question. Research shows that adults often do not talk as much or as long to children without eye contact. Adults should be aware of this and monitor their behavior with children.

The child sees best in uncluttered, quiet places. (Complexity)

  • Provide quieter environments
  • Create morning meetings of less children so the movement, visual complexity and auditory complexity is more controllable. There is no rule that morning meeting needs to be all the children in one morning meeting. Have several smaller meetings.
  • Provide non-complex backgrounds for all learning materials.
  • Where non-complex shirts. You are the the visual background!
  • Seat yourself in the same position as the child to see what the child sees. You will be surprised how much visual complexity you will notice and need to control.
  • Position this child solidly for best visual skill use.

The child only looks at familiar and favorite toys. (Novelty)

  • Use familiar materials.
  • Use consistent materials to build visual familiarity.
  • Predictable routines in morning meeting will support visual recognition of materials and help children predict the sequences.

The child has a long delay before they turn to look. (Latency)

  • The child will have latency for looking and latency for understanding what is seen. Using the assessment and taking data will help identify how long the child requires for visual attention, which visual field is faster and which visual field has the most sustained visual attention abilities. The material needs to be where the learning is accessible and for as long as the child requires.

 

Importance of Color

So many times I see professionals mark the CVI Characteristic of “Color” as “Resolved” as soon as a child looks at more than a single favorite color. (Roman-Lantzy CVI Range 2007).

This is a great misconception. Marking the Color characteristic as “Resolved” means that color is no more important to the child than to a typically developing peer. (Roman-Lantzy)

Color remains important for many children assessed much higher in the CVI Range. I recently assessed a child in a typical kindergarten. Careful interviewing of parents and his team plus observations and direct assessment uncovered this important information about this child’s color preferences:

Parent/Team Interview (Roman-Lantzy):

  • This child’s parents immediately report “red” as a favorite color. He always picks red clothing, red toys and wants to paint his room red.
  • This child’s teacher immediately was able to state that “red” was this child’s favorite color. When I asked this teacher whether he knew the favorite color for other children in the class, the answer was “no”. (This color preference for this child with CVI was strikingly evident for a teacher with 14 other students in the class!)

My observations and direct assessment revealed:

  • This child looks at all colors and colored patterns.
  • This child does have a distinct preference for the color red for visual attention at near and distance.
  • This child was observed visually locating and then following a peer dressed in red or orange when told to line up, when evacuating the building in a fire drill and when outside on the playground.
  • Told to pick items for decorating a snowman in Art, this child walks completely around the table to chose a red ribbon for the scarf.
  • Walking the hallway to Art, this child was observed to have increased visual attention to red items in the hallway on all planes (materials on the floor, wall, above to the red Exit signs and to children dressed in red walking by).
  • In the Speech session, this child picks red pirate game piece and has great sustained visual attention to the red, lighted spinner.
  • Asked to pick a marker for an activity, this child picked the red marker every time.
  • Asked about a bowl choice, he asked for the red one.

If we know this child has such a strong color preference, we can infuse this color into activities that are difficult for him:

  • Added to the locker hook to hang up his coat
  • Added on the classroom sign-in sheet to highlight where to place his name.
  • To draw his visual attention to salient learning features.
  • Added to the envelop edge to help him place the paper into the folder.

Missing this vital information about color, misses a great learning accommodation for visual functioning.

 

Brain Plasticity

I just attended a meeting where the school psychologist stated “This child’s skills have plateaued”. Such old and erroneous information! Even with the scientific evident to the contrary, some professional continue to propagate this brain science myth. This is a dangerous myth. It sets a mindset that lowers a team’s expectations for a child’s continued learning across all skills.

In schools, there continues to be a misconception that brain plasticity is fixed to ages between 0 and 3 years old. While it seems true that the young brain learns and reassigns best, this does not mean that after age three, we do not have the expectation for improvements for all skills including visual skills. The brain has great plasticity all through life so we must expect improvements or we will most certainly not get them! We must continue to provide each child with the needed supports. Of course, these needs are determined after careful assessment using the correct tools that measures where and how the child is functioning. For a child with CVI, the correct assessment for functional vision is the CVI Range (Christine Roman-Lantzy 2007).

Knowing where and how a child is functioning is the only way to provide first: optimal visual access and second: build visual skills. We move from current functioning, determine the next steps and create goals and objective for improvement. The CVI Range provides us with an assessment tool to measures that improvement.

Here are some resources that I shared with that psychologist, parents and the team:

Psychology Today: Brain Plasticity in Older Adults https://www.psychologytoday.com/blog/iage/201304/brain-plasticity-in-older-adults

Dr. Lofti Merabet Looking Inside the Adaptive Brain
https://videocast.nih.gov/summary.asp?Live=16959&bhcp=1

Powerpoint Books: Matching to Assessed Visual Needs

Literacy is so important for every child. I love making Powerpoint books for my students with CVI. You can make these for the class as a whole based on a thematic unit or make individual books tailored to each child’s visual needs and preferences.
Using Powerpoint books allows me to use strategies matched to the child’s assessed visual needs using the CVI Range (Christine Roman-Lantzy 2007)
Color: I use the assessed color preferences that I has discovered in my assessment.
Movement: I can insert slight movement as needed using an inserted film clip. I also like to insert films to build cognitive understanding. If the child will look at a plastic toy fish, I do not want they to believe that “fish” are hard plastic, non-moving things. I want to build understanding of how they move, where they live and to have the child understand that fish come in different colors and shapes. I can insert a film clip of fish in a fish tank. I can talk about how fish are alive, breathe, have different colors, swim in water and how they move. Children with typical vision have this information without direct teaching. I want my students to have the same access.
Latency: The images on the pages can stay present for as long as a child needs.
Visual Fields: The device using the Powerpoint can be placed in the best visual field. This is often at eye level.
Complexity: Powerpoint books allow me to choose a non-complex background for each slide page. If I take my own photographs or grab images from Google, I can Edit and erase all complexity before I insert the picture. If I take film, I can make sure that film is non-complex.
Lightgazing: Because the Powerpoint is created on a computer or backlighted device, the child’s need for light is satisfied.
Distance Viewing: The device playing the Powerpoint can be placed at the child’s assessed best visual distance.
Visual Reflexive Responses: No strategy addresses a reflex. This is a characteristic of CVI but not one we program for.
Visual Novelty: Children will look at familiar items better than non-familiar ones. Using pictures of familiar items and creating books about familiar topics, events or predictable sequences are much more likely to draw a child’s visual attention and interest. Remember that all children like predictable books!
Visual Motor: Visual attention is important for literacy but the ultimate goal is always independence to control the book and choice of books. With the ability to turn to the next page or to indicate a desire for a different book is often visual motor task. To encourage visual motor, there must be an access method that is matched to the child’s assessed visual skills to find and reach.

Here is a Youtube explanation of how to make the Powerpoint book https://www.youtube.com/watch?v=tYQCwowU8sk