communication

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

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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.

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!

 

Non-Complex Concept/Choice Board

To reduce complexity on a concept/choice board, I used corrugated black plastic to create the board.  I used black Velcro so the Velcro would not become another item in the array. (It disappears against the black plastic).

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I wanted to be able to notice any visual behaviors so created a window. I was concerned that my eyes and face would become another item in the array. Using black screen like the kind used in window screens, I covered the peek hole. Now this board can be held up at the child’s best distance and at her eye level. I can watch exactly where she is looking and at what she is looking no matter how quickly she looks. I can reach around the board and create movement to draw her visual attention to the described item.

Version 2

This is really helping the team understand whether this child understands the visual information, the concept being discussed and or the choices being made. I can present 1, 2, 3 or 4 icons on this board depending on the child’s assessed array tolerance using the CVI Range (Roman-Lantzy 2007)

Lack of Visual Access Masks Language/Cognitive Abilities

Young Jack, who has CVI, is in school where the team was using pictures in his communication system. Jack seemed to show no understanding that the picture of the “spoon” represented “snack”. When he wants snack he whines or cries until someone familiar with his limited communication gets him a snack.  It is so hard for Jack to show adults what he knows or understands. His abilities to communicate using symbolic representations seems severely limited.

The new TVI assessed Jack using the CVI Range (Roman-Lantzy 2007) around the 10 characteristics. She determined that 2D pictures were visually inaccessible for this child. She advocated for the change from 2D photographs to 3D symbols for his communication.

With this new 3D symbol system, “snack” is represented as a spoon mounted on a black 5’X7” card.

  ph-one-glitter-spooncvi-001

Jack began to show adults that he indeed understood the new 3D symbol system.

  • Jack smiles when seeing the 3D symbol for “snack”.
  • Jack consistently chooses the “snack” symbol when given a choice of “snack” or a foil. (A foil is a meaningless object or a non-preferred object)

For more about “foils” see    http://www.swaaac.com/files/assessandimp/aacbasicsandimplementationbook.pdf under “Implementation” section.

  • Jack pulls people towards the snack table when presented with the 3D “snack” symbol.

Jack also began showing similar understanding of other 3D symbols in his new communication system.

3 imbedded symbols

When using photographs, Jack’s abilities to communicate using 2D symbolic representations seemed severely limited until the assessment using the CVI Range (Roman-Lantzy 2007) determined that these 2D photographs were beyond his visual abilities. Creating symbols in 3D that are accessible allows Jack to truly communicate his wants and needs. This ability shows the team what Jack is capable of.

The collaboration between a TVI who understands CVI and the team puts Jack on the road to building communication. Jack looks more capable as he is now able to show what he understands. The team has higher expectations for his learning. The building successes using the 3D symbol system can later be thoughtfully transitioned to photographic symbols in planned way based on his visual understanding.

 

 

Fall CVI School Checklist

Fall is here and schools are opening their doors to students.  The fall is an exciting, fresh beginning that I look forward to each year! It is an especially busy for TVIs as we assess children, educate staff, adapt materials and environments and support parents, students and teams.

Here is a fall checklist for CVI for Teachers of Students with Visual Impairments:

  1. Complete CVI Range (Roman-Lantzy 2007) for all students.

All TVIs should become “CVI Endorsed”.  The online CVI workshop will solidify your knowledge of CVI if you have never taken an in depth class about CVI. In the endorsement process, you will be asked to pass a multiple choice test and then to score 3 children with CVI. This endorsement will prove your competency using the CVI Range for assessment.

Perkins CVI Endorsement http://www.perkinselearning.org/cvi-endorsement .

There are just too many people using the CVI Range incorrectly. If the Range is not used correctly the results will not provide the child with the correct goals and objectives or the correct adaptations, accommodations and methodologies needed for their optimal visual functioning. This misalignment will limit the child’s visual improvements.

  1. Share CVI Range results with parents. Parents will benefit from a discussion about the overall concepts of CVI so they fully understand their child’s visual skills and needs after the assessment. With this fuller understanding about CVI, they can more effectively understand their child’s CVI Range score. With this background knowledge, the accommodations, modifications and environmental supports make sense. Parents need this background information to advocate for their child across a lifetime, every year as staff and schools change.
  2. Conduct and inservice to the educational team about the overall topic of CVI. With a firm understanding of the CVI concepts, teams can better understand their students visual functioning and their unique educational needs. The accommodations, modifications and environmental supports have more context and will be more consistently used if fully understood.
  3. Conduct a second inservice to the team about how CVI effects each individual student. Children, even with the same score on the CVI Range, have unique educational needs based on their own individual assessment results around each of the 10 CVI Characteristics (Roman-Lantzy).
  4. When classroom schedules are completed, look across the learning day to ensure the CVI adaptations are in place at all times.

(Example: In morning meeting the child is at the correct distance from the learning materials (Distance Characteristic), has visual access to the better visual field (Visual Field Characteristic), has an identified “wait time” (Latency Characteristic), has materials in the most accessible color (Color Characteristic), has the light controlled and used optimally (Light Gazing Characteristic), has the movement distractions removed or movement used to draw visual attention (Movement Characteristic), and has the complexity of the environment matched to the assessed need (Complexity Characteristic).

  1. Create a “cheat sheet” to hang in learning areas so staff can quickly refer to the recommendations for best visual field, best distance, best best color, and other CVI recommendations around assessed needs.
  2. Check that the classroom has areas for learning that are adapted to assessed CVI needs. If the child requires a non-complex, quiet separate learning area to preview materials or to learn skills this needs to be an identified and provided area for learning.

How Does This Make Sense?

Some children are assessed using the Christine Roman-Lantzy CVI Range and their visual skills are measured as operating in Phase I. Here is what we know about children in Phase I (Christine Roman-Lantzy)

  • The child has great difficulty locating items in the environment and looking long enough to recognize them.
  • The child lacks visual memory for items in their environment due to this limited looking.
  • The child has a favorite color and will only look at simple one colored items. (Color)
  • The child looks at movement or shiny items but does not seem interested in stable objects. (Movement)
  • There is no or little reaction to visual threat or touch between the eyes. (Visual Reflexive Responses)
  • The child fixates briefly but likes light, ceiling fans and movement. (Light gazing and Movement)
  • The child sees things in the peripheral fields but does not react to items in central vision positions. (Visual Fields)
  • There is visual attention in near space only within 2 feet. (Distance and Complexity)
  • The child rarely looks towards faces (Complexity).
  • The child sees best in uncluttered, quiet places. (Complexity)
  • The child only looks at familiar and favorite toys. (Novelty)
  • The child has a long delay before they turn to look. (Latency)

The child enters school and icons, that very symbolically represent materials, are used.  How does this make sense?

  • The child is not looking at 3 dimensional things in their environment. The icons are 2 dimensional and represent these things. How is the child expected to connect the 2D symbol to an 3D item they can’t look at and can’t recognize??

IMG_0505

  • This child is very visually impaired yet pictures are used??
  • The child, if they can locate items, can only tolerate looking at one 3 dimensional item at a time, yet they are presented with a HUGE amount of symbols on a communication system.

device

  • The child can only look at items that move yet symbols are presented as stable items??
  • The child is constantly told to “look” using central vision, yet it is their peripheral vision which is the most functional.
  • The child is presented with 2 dimensional pictures the represent part of an object (which they can’t recognize in 3 dimensions!).

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Teachers of students with visual impairments who understand CVI and how to assess CVI using the CVI Range must work hard to help teams understand this disconnect. Without the vital information gained from the CVI Range, the communication device materials and other 2D learning materials are inaccessible. Would we ever do this to a child with an ocular impairment?? I don’t think so!

Testing Visual Array Threshold

It is very important to determine the exact number of items in a presentation that a child can look at and recognize (Christine Roman –Lantzy “Complexity of Array”).  I need to always be sure a child can discriminate one item from others as a visual skill before I use larger arrays for teaching. To begin to assess this, I use that child’s very favorite item in a decreasing number of dissimilar items.  I present that favorite item in an array of 6 items, then 5 items, then 4 items, then 3 items and finally 2 items until I see the child look towards and recognize their favorite. I conduct this assessment over a series of days, taking data on the attributes of the presented items (in the same environment), the number of items and the time the child needed to find their favorite one. If they have the ability to reach, I look at the quality of reaching (direct reach while looking, direct reach while looking away, sweeping reach while looking or sweeping reach while looking away).  Once I have data about the child’s abilities with increasing arrays, I can make recommendations to the team about the number of items that can be visually tolerated for recognition to occur.

Finally, I would want to test this array tolerance with items that are similar to one another as well but if I am testing this at all, it means I am concerned about this tolerance of array.  The recommendation for dissimilar materials is always in place for ease of discrimination in all situations with all alert states and in all environments.

Throughout this testing, I use dissimilar materials; all different from one another in color, shape and size. Recommendations to the team must include a suggestion for any array, especially with symbol systems, to highlight the need for items used to be of great dissimilarity.

 

Calendar Systems for Children with CVI

Children with typical vision have access to all the information in their environment. They can see and anticipate what will happen. They see Dad getting his coat on and understand he is going out. They see the teacher organizing art supplies and understand that art will happen soon.

Depending on the CVI Phase, children with CVI have limited visual understanding or limited distance and understanding. Life seems random as things change throughout their day.

Calendar systems create access by linking symbols to events. It builds both symbol understanding and anticipation of what will happen next. It creates temporal understanding: first, now, next, all done (past), it fosters sequencing (first, next, after).

The setup and visual access of the calendar system must match the child’s CVI Range score (please refer to Cortical Visual Impairment: An Approach to Assessment and Intervention by Christine Roman-Lantzy)

 

Here is one example:

Screen Shot 2015-05-01 at 12.02.52 PM

 

The CVI Range assessment for this child indicated that the child is able to look at 7 items at the same time (complexity of array). The CVI Range indicated that child can not understand 2D pictures or images so the teacher choose 3D embedded symbols (complexity characteristic). The CVI Range indicated the child could look at all colors so many colors are used (color characteristic). The child can look at these symbols without movement so the symbols can be presented in a stable fashion (movement characteristic). The calendar system’s consistent use all day every day will build familiarity (novelty characteristic). Light can be controlled (lightgazing). The calendar system can be presented in the child’s best visual field (visual field characteristic). The calendar system can be presented as long as needed for the child to look (latency characteristic) and reach (visual motor characteristic). The calendar system can be presented at the optimal distance determined by the assessment (distance characteristic)

More ideas for calendar systems at Adaptive Design at adaptivedesign.org

The teacher chose items to represent each activity. Each symbols is within the child’s tactile, visual and auditory experience:

  • Ball for gym
  • Paintbrush for art
  • Spoon for lunch
  • Book for reading
  • Bells for music