Assessment

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..

Advertisements

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 23rd to December 10th, 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

Rebecca Davis: Parent blog

Please check out the latest parent blog: CVI Momifesto at

https://cvimomifesto.com/?wref=bif

The subtext of the blog is “Building a Community of Parents of Children with CVI”

Historically, it is the work of parents, organizing and advocating that causes changes in the service to children. I think of the work of parents of children with autism as they organized and advocated for better research, better identification, better funding and more paid services for their children. The parents of children affected with RETT syndrome and related disorders are another wonderful model group for parent advocacy. They came together to advocate for awareness of RETT syndrome, RETT research and funding and they created assessment centers all over the country to serve their children.

Parents with children affected by CVI need to do the same. They need to come together with one voice that will bring the topic of CVI to the forefront. I monitor many Facebook pages that parents have created. They share heartbreaking stories of navigating the misinformation from medical professionals and educators as they seek the best services for their child.

The information about CVI is now decades old and building everyday. Why does it fall on the shoulders of parents with the least free time to organize this effort to help medical professionals and educator understand CVI and how CVI affects learning?  Professionals who understand CVI are out there but they are not sitting at your child’s IEP. That is where the advocacy must begin.

As parents and professionals who understand CVI, let’s begin to build the documented evidence for the IEP process that fosters the diagnosis of CVI. Let’s make sure the students are assessed using the correct tools such as the CVI Range (Roman-Lantzy). Let’s make the CVI Endorsement (through Perkins School for the Blind) mandatory for professionals working with each child. Let’s make sure there is not “vision time” but consideration of visual needs around the day and across the curriculum.

Check out Rebecca’s blog!

 

Two Interconnected Expanded Core Curriculum Areas for Children with CVI

As a Teacher of Student with Visual Impairments, I am certainly focused on the improvement of visual skills for my students with CVI. I am also interested in how my students understand everything that is easily understood by their sighted peers due to their incidental learning. These intertwined Expanded Core Curriculum (ECC) areas must be considered for that equal access.

These two important areas of the Expanded Core Curriculum must be considered separately and together. These are:

  1. Sensory efficiency skills
  2. Compensatory Skills, Functional Academic Skills (Including Communication Modes)

Sensory Efficiency Skills: This area is especially important for the child with CVI but in a totally different way than that considered for a child with ocular impairments. We are expecting improvement for student with CVI. Functional visual assessment using the CVI Range (Roman-Lantzy 2007) provides the baseline for functional visual skills and sets the stage for this improvement using strategies and objectives matched to the assessed needs.

Compensatory Skills, Functional Academic Skills: This area must be considered to support the
building functional vision of the student with CVI. Vision is the distance sense that supports what is heard, smelled, felt and tasted.

Think about a classroom where someone drops something. The child with typical visual abilities can turn, look and determine what made the sound and determine that the sound is not a threat. The student with CVI hears the item drop and due to lack of visual location abilities or lack of distance abilities, does not turn, does not understand what made the sound and might remain in a state of stress wondering if this sound is a threat or not. We need to build this understanding of environmental sounds by labeling the sound, bringing the child closer to the sound, bringing the sound to them and allowing them to make the sound themselves for complete understanding. If someone drops a tray in the classroom, I make sure to bring a tray to the child and allow them to see it, feel it and push it off the tray to create the sound. Once understood, the sound will not create stress and allow the child to return to the learning. This approach provides the student with the same access to the visual, auditory, tactile, cognitive/language information enjoyed by their sighted peers.

For functional academics, focus needs to consistently be on ways to create and foster the highest level of independence possible to live and work in the future. These are skills that should be worked on from birth! Think of the value of organizational skills for a child with limited visual abilities. Getting objects from a storage place and returning the item to that store place when completed builds independence and understanding of the student’s environment.

For communication the CVI Range can help us determine whether we provide tactile sign language to the student with deafblindness or just visually presented sign. If the child is only using peripheral vision, they could never see and understand the small, distinct visual-only sign that requires central vision use. If a communication device is used, the CVI Range provides information about the accessibility of pictures, the ability to recognize pictures, the number of items that can be seen and recognized at one time (complexity of array), and what size is needed (due to complexity not acuity!). For literacy and communication, the CVI Range provides information about the unique need for color highlighting, spacing and print size (due to complexity not acuity!)

All students with visual impairments need the ECC considered and provided in their educational programming. Students with CVI have the same educational needs but with consideration that CVI is completely different from ocular impairments.

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!