embedded strategies for CVI

Supporting Language for Salient Feature Understanding

In the CVI world there is great emphasis on salient feature support for children with CVI (Roman-Lantzy). This is the consistent visual description language that is used to help children with CVI understand what they see.

It is also important to remember that children with visual impairments often lack understanding of the basis of these language concepts.

They lack understanding of the meanings of position/directional words and any adjectives describing size, shape, number and sometimes colors.

Adjectives used in this salient feature language such as “long”, “tall”, “flat”, round”, “curvy”, “pointy”, “floppy”, “wagging”, or “skinny” may be meaningless without direct teaching of these concepts.

Position words: used in this salient feature language such as “middle”, “over”, “under”, “top”, “bottom”, or “upside down” are irrelevant without the context for position in space that is taught and directly experienced.

Shapes: used in this salient feature language such as “rectangle”, square”, “circle”, “triangle”, or “center” lack meaning without tactile and visual exploration directly with real items of those shapes.

Number and Size: used in this salient feature language such as “two”, “one of each”, “single”, “short”, “large” are not well understood without direct and repeated teaching of number and size that children with typical visual skills understand through everyday incidental visual experiences. Think about this example of everyday incidental interactions that teach number, quantity and size:

Mom has 3 cookies: 2 small and 1 larger one. She gives 1 small cookie to Billy. Billy sees that mom now has 2 cookies: 1 small and 1 larger. Billy, of course, notices that mom still has “more”: the larger one and a small one while he has the other small cookie.

Children must have multiple understanding of words. If the concept is long, the child must learn that there are multiple kinds of long, that is not a narrow meaning.

“Long” can mean:

  • A distance
  • A length of time
  • Many (as in “a long list”)
  • Long sounds
  • Long hair
  • Long item (as in “long ruler”)

Without directly teaching these concepts for essential language and cognitive understanding, salient feature language is empty language with minimal meaning behind the words.

We must build concepts with direct teaching with hands-on experience with real materials in 3D. Providing learning materials in 2D without this direct teaching will not provide these concepts.

Salient feature language can not be the support we want for building children’s visual understanding without doing this background work to solidify the understanding of the words and the concepts.

https://www.tsbvi.edu/curriculum-a-publications/3/1069-preschool-children-with-visual-impairments-by-virginia-bishop

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Central Focus for CVI: “How Does This Benefit Kids and Families?”

I have the pleasure of working at Perkins School for the Blind as the CVI Program Manager. My supervisor, Ed Bosso, has one central question for me every time we meet:

“How does this benefit kids and families?”

I try to take that question into consideration for everything I do.

  • How does this statement benefit kids and families?
  • How does this interaction benefit kids and families?
  • How does this idea benefit kids and families?
  • How does this CVI training benefit kids and families?
  • How does this assessment benefit kids and families?
  • How does this collaboration benefit kids and families?

There is certainly increasing understanding of CVI since I first learned about it in 2002. Now our task is to stay focused and to use that building energy and building understanding creatively, scientifically and collaboratively to move this field forward in all ways.

To support the medical field, the educational field and research field in understanding CVI, that central question, “How does this benefit kids and families?”, should be the first question we ask ourselves. Absolutely nothing else matters…

Accessible: Visual Recognition in Literacy

Many strategies for CVI that we see on the internet give us suggestions for visual access in literacy for students with CVI but they slip back into ocular suggestions: good contrast, larger size, reduced glare on the reflective page.

What is totally missed is the important concept that CVI is an issue of visual recognition. If the child has no firm idea of the item in real life, in real 3D form, we simply can’t then go to 2D pictures as a symbolic representation of that item.

Without visual recognition of things in the world, the flat, 2D images are merely squares of color and shape not a meaningful picture representation of anything recognizable.

Children may look at the images but the representation remains meaningless and inaccessible

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.

Have You Really Controlled the Complexity and Light?

Complexity and access to distracting light and movement can completely overwhelm the student with CVI in the classroom. I have seen teachers work very hard to reduce the complexity of their classrooms. It can be a challenge but well worth every effort for our students with visual impairments due to CVI. Controlling complexity and light effectively creates accessibility to learning.

Take a look at this classroom: (Pinterest)

 

This teacher has covered the shelves that are probably filled with toys and books. The shades are pulled down to control distracting light sources. The floor cover is a nice non-complex background for looking at materials placed on the rug. A nice start!

BUT: look at the shelves in on the left side of the room. The black cover controls the complexity on the shelves but the complexity remains with the many colorful and complex materials stored on top. If those toys were removed, that left side of the room would be a much less complex background against which to learn. (Complexity of Array: Roman-Lantzy). That is, of course, if that is the way the student in facing in the room!

If the student is facing the right side of the room or learning in the middle of the room, that would be completely overwhelming and complex. If the student is facing this way and this is the background, the student would really struggle against this complexity of array. This side of the room is completely inaccessible for learning for the student with CVI.

Here is a challenge for everyone as you return to school from the holiday break. Pick a student in your class who has CVI. Think about every position you place that student throughout the day. Actually sit there. Is the background where the student is facing free of complexity? If not, rethink your adaptations so the whole room is adapted. Would there be a better place to face? Would learning against a wall rather than in the middle of the classroom be best? Accessible learning is from the student’s point of view not from ours.

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

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.

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.

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 in Phase III. 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.