Take a Seat!

Watch your children with CVI move to get into a chair. So often I see this done tactilely. They turn and backup slowly until they feel the chair seat against the back of their legs. I believe this is due to the difficulties judging distance, the visual complexity of this task and visual motor difficulties.

I have had great luck working with the PT and OT to help children understand where the chair is in space and how to move their body into the seated position.

Here is one example. Just by placing red tape on one arm of the modified toilet we could teach the child to find the highlighted armrest of the chair, cross midline, hold the red highlighted area to stabilize their body and to turn to sit. As they improved their skills, we were able to reduce the size of the color highlighting and finally remove it. This provided safe and more independent toileting.

 

 

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..

Using Color Highlighting Effectively for Students with CVI

Color is such an important tool to use for students with CVI in all Phases (Roman-Lantzy).

In Phase I, color can support initial visual location using the student’s preferred color. Identifying that preferred color in assessment can be the key to building more functional vision

In Phase II and III, carefully use of color highlighting can facilitate vision for function. Color highlighting in these Phases will help support understanding of where materials are in space, where to place materials and where to reach to grab effectively. It can be used to draw visual attention and to support discrimination using highlighting of salient features in communications systems and literacy. For Orientation and Mobility, color can support distance attention and understanding. Color highlighting must be well understood and well applied for the optimal benefit when building student visual learning.

Check out this Perkins E-Learning Teachable Moment I recently did to learn more!

http://www.perkinselearning.org/videos/teachable-moment/color-highlighting-children-cvi

Color Highlighted Drum for Increased Accuracy

One of my student was having trouble hitting the Paddle Drum with any accuracy. My husband created a red lighted dot in the middle of the paddle with a bright LED light. It worked wonders! The lighted area drew visual attention to the middle of the drum surface and the student could more accurately find and hit the right area. Success was immediate!

         

My husband placed a metal crosspiece across the back of the drum on the outside ring support and placed the LED onto that with a battery pack. It has an on and off switch for ease. Having the structure off the drum surface did not interfere with the created sound. The lighted drum picture example did not transfer so well. In real life, it is a very bright red dot not the white dot in the picture here.

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 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 assessment 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 assessment 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 assessment 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.

Specific Ipad Apps for Phase III: Matt Tietjen

Much thanks to guest blogger, Matt Tietjen, for these specific ideas to use an iPad to support students. Invaluable!

Goodnotes: You can take pictures of educational materials, zoom in on important details, isolate one problem or diagram at once and also write on it.  You can use the writing feature to highlight salient features, or the student can use the writing feature to complete the assignment. For example, I have a student who does best with one math problem per page rather than several.  Each morning of the week, her class gets a “morning math” worksheet with several problems on it.  The paraprofessional would use Goodnotes to take a picture of each problem on the worksheet and quickly create a digital notebook for that worksheet, with one problem per page. The student could then flip through the notebook and write on the iPad to solve one problem at a time.  Her final product could be saved in a folder on the iPad and also turned in by emailing it to the teacher or uploading it to apps like Google Drive or Dropbox.

Snaptype: Very useful for minimizing complexity in worksheets by taking a picture of a worksheet, zooming in on one problem at a time, and allow the student to type an answer for each problem using the onscreen keyboard or an adapted Bluetooth keyboard. Great for math worksheets!

Photo Album/ Camera: Yup! Just the regular old photo album and camera on the iPad. Can be used to reduce complexity and capture distance information in so many ways. Here are some ways I am using it:

• For all those circle times/morning meetings when the teacher may only decide a few minutes ahead of time what book she is going to read, the para can get the student’s iPad and snap a picture of each page (only takes a few minutes to do an entire book). The student now has a personal copy of the book on her iPad that she (or staff) can flip through to follow along with the teacher and zoom in on any important details, masking out irrelevant surrounding information on each page.
• Create an “album” for wall materials. Take pictures of each poster, word wall, map, etc. on the classroom wall and save them to an album on the student’s iPad. That way, when the teacher is referring to that map, word wall, etc., the student can follow along and zoom in on the pictures at her desk.

Bitsboard: Awesome for making custom flashcard activities for touching a named picture, reading bubble outlines without words in them, touching a picture from an array when its salient features are named, etc.  You can use this app to create custom picture touch games using anything you want – photographs of the child’s favorite objects, 2D image assessments, letters, numbers, words, etc. Many of my students like it a lot.

Counting Bear: Great for math. It visually marks each item as you count it. Students still have to practice systematically searching the array of items in order to count but with the support of visual markers to help them keep track of what has already been counted and what items still need to be counted.

Pictello: Fantastic for making custom made stories – either modifications of actual children’s books, experience stories or stories that the student helps write. You can include pictures, photographs, videos, etc. as part of the story and it reads the story aloud to the student. Can be great for creating school-to-home daily or weekly communication logs where the student helps take pictures of items throughout her day and then uses the app at home to communicate about her day to her family. She could also use the app with her family to create experience stories about vacations and special events to share with friends and teachers at school. For example, a student could take pictures of her weekend activities and create a story called “my weekend” that she shares with her class during morning meeting.

Voicedream app: You can use this app to read (or listen to) any pdf or word document as well as anything from Bookshare. It has a more natural reading voice than some of the other text to voice apps (in my opinion). You can adjust font style and size, and you can set the app to mask some of the text so that it only shows one line at a time, 3 lines, or 5.  It also has a yellow highlight that moves from word to word as the automated voice reads.

YouDoodle: can use it to import pictures and highlight salient features (as Christine Roman-Lantzy has taught us). I also have a student who likes using it himself to highlight salient features on photographs he has taken.

Google Images and Youtube: I use Youtube and Google images quite a bit.  If I wanted to bring distance info. (like giraffes) to a student who was about to visit the zoo, I might show him a few videos on the Youtube app about giraffes and where they live.  When there is an abstract picture in a children’s book (which is almost always) I often open up Google Images and find a real photograph version of the same thing and compare the salient features between the real photograph and the more abstract illustration in the book.

Calculators: for students high on The Range and in the upper grades, using scientific and graphing calculators can be a real challenge due to complexity of array.  It seems that calculators that incorporate color coding to reduce complexity of array may be a better choice for many kids with CVI. Here are a few promising ones:

• Kalkulilo Scientific Calculator: uses color coding to help reduce the visual complexity of the keyboard and group keys by function.
• Scientific Graphing Calculator (William Jockusch): Each graph on a coordinate plane is a different color and is color-coded to match the equation that goes with it. This type of color coding really helped my high school student in algebra II this year.  She had a physical TI-84 Plus calculator, not this app, but it was color coded similarly.
• Calculator (Infinity Symbol) incpt.Mobis:  This calculator uses color to differentiate symbols from numbers and other parts of the equation. Can help reduce complexity of array.

What Do iPads Do to Support Students

As discussed many, many times, the strategies for CVI must match the assessment results. 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 who struggle with visual recognition. 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 who struggle with visual recognition?

Impact of Color: The student might benefit from color highlighting to draw visual attention to specific areas on 3D and 2D materials. That color supports visual attention to the specific place.

Light: Backlighting can helps foster access to materials especially in 2D (pictures and text). Some children do not benefit from backlighting and this should be part of the assessment.

Visual Processing Time: There is still a need for increased time for full visual exploration and full visual understanding.

Visual Field: Lower visual fields might be affected in some children. Other children struggle with visual attention in all fields or “hyper attention” if the scene is too complex. (attends to just one part not taking in the whole scene).

Visual Recognition: Presenting new materials in new kinds of presentations might require the verbal narration of visual attributes.

Clutter: Clutter can affects visual understanding of objects, increased display clutter, 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? 

Impact of 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.

Visual Processing Time:

• 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 Recognition:

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

Visual Clutter and Access:

• 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.
• Visual attributes of items in photographs and as part of texts.
• Increasing spacing of words and sentences to reduce clutter.
• Masking: clutter 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.

Importance of Color

Color is so important for many children with CVI.  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

• 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!)
• the child codes by color against complexity and at distance. He picks the wrong yellow toy from a toy box when searching for his favorite yellow truck. He moves to to the wrong purple box at 10 feet thinking it is his backpack.

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 but all colors are used for recognition.
• 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.

Remember “preference” does not mean this color is the “only” accessible color.

 

Ordering Luggage Handles

Here is the ordering information from Amazon

Color Highlighting: Luggage Handle Wraps

For color highlighting, I can’t always use my favorite colored duct tap to help students with CVI to visual locate and understand where to grab/where to hold for best access. I found these removable red luggage handle wraps that quickly and easily can be applied to provide that access. In the pictures here in the community, my student who locates the color red best, is using the red luggage handles on a shopping cart in the store and on the bowling frame during a recreational activity. The extra benefit is that these handles have a unique, “squishy” texture that provides a tactile cue.