Assessment

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:

 

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 CVI Range assessment (Roman-Lantzy) gives us a great idea of functioning across the environments and across people.

  • 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 observations part of the CVI Range gives us the functioning in a less adapted learning environment (for now!).
  • 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.

Perkins-Roman CVI Range© Endorsement: Exploring a Myth

The issue of competency for TVI’s serving students with CVI is such an important issue in the field of service to students with visual impairments caused by CVI. There is little coordinated education provided in teacher training programs for TVIs, O&M Specialist and Vision Rehabilitation Specialist. There is no way for parents and school systems to understand whether vision professionals have the extensive education about the visual brain, how the visual system operates, how to assess the unique visual behaviors of students with CVI and how to support the educational teams to create accessible instruction that lead to visual improvements.

One step taken by Perkins School for the Blind and Dr. Christine Roman-Lantzy is to create the Perkins-Roman CVI Range© Endorsement. It requires vision professionals to show basic understanding of CVI: history of the building understanding of CVI, definition of CVI, medical causes, and the visual behavioral characteristics.It also asks applicants to prove competence in using the CVI Range, a widely used tool for assessment.

Christine Roman-Lantzy is the creator of the CVI Range and has determined that it is being used widely but incorrectly leading to incorrect scoring. These incorrect scores lead to lack of identification of students, dismissal of students from service, incorrect goals and objectives and ineffective environmental and learning strategies to support visual access and visual improvements.

A frequently heard myth:

“There is a great deal of money being made by Dr. Roman and Perkins School for the Blind”

I contacted Mary Zatta of Perkins elearning to ask her about this issue. She explained that this is not an automated process and that the administrative fee of $125.00 barely covered the expense of awarding the CVI Endorsement. She outlined the intense staffing and man-hours required by 3 full time staff members to review applications, to review recommendation letters, to contact the source of the recommendations, to monitor progress of the written test, to prepare and provide 2 video case studies per applicant, review those submitted CVI Range scores for accuracy, to ensure the applicant is within the margin or error, to provide feedback, to monitor and answer questions, and to provide unlimited live office hours for questions.

Dr. Roman Lantzy receives no money from the Endorsements.

Given that, $125.00 seems appropriate and reasonable!

Understanding What is Seen

For students with CVI, understanding what is seen is based on previous knowledge and the expanded understanding of salient visual features (Roman-Lantzy).

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 and 6.5 on The CVI Range, “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 the salient visual 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 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!