environments for CVI

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!

Visual Experience, Experience, Experience

For science nerds like me!

“Neuroscientists Reveal How the Brain Learns to Recognize Objects”

https://www.sciencedaily.com/releases/2010/09/100922121937.htm

This article comes from work being conducted at Massachusetts Institute of Technology (MIT). They are studying how humans process visual information for recognition so they can design artificial visual systems. It seems vision is such a complex process! I think parents and teacher have understood this for years!

This great article that drives home the brain’s need for repeated experience to build visual understanding. The brain must have repeated experiences with objects in different kinds of positions, perspectives, lighting, size and distance. It reminds me to provide my students with real objects in repeated, predictable routines to build familiarity. It reminds me not it only present iPad visual targets that can’t be manipulated. The child builds visual recognition from the presentation of objects in multiple positions to view multiple perspectives. If the child is not able to manipulate material themselves, we must provide that varying visual perspective.

This is a reaffirmation of the characteristic of Novelty that Dr. Christine Roman-Lantzy discusses (Roman-Lantzy CVI Range 2007)

 

 

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!

 

Morning Meeting Ideas for Children in Phase I

I had a request for some morning meeting ideas for children in Phase I as measured on the CVI Range (Christine Roman-Lantzy 2007). The concepts and vocabulary around “Characteristics” and “Phases” come from Dr. Roman-Lantzy’s work.

The first place to start, of course, is to assess the child using the CVI Range. This is the only functional vision assessment for children with CVI. Understanding the child’s functional visual skills allows you to create goals and objectives and to provide across-the-day accommodations and methodologies to meet those needs.

Phase I:  Goal: Building Visual Behaviors. Providing access to use visual skills around the 10 characteristics.

The child has a favorite color and will only look at simple one colored items. (Color)

  • Materials in morning meeting must meet the color preference. This is not always red o yellow. Your assessment will tell you the preferred color. Because this child is very visually impaired, compensatory skills should also be considered. Items presented must be 3D, real objects NOT PICTURES! 3D objects will provide visual access, tactile input, olfactory input and auditory input.

Pictures are completely inaccessible for this child who is not using central vision   effectively. (Central vision is essential for children to understand any 2D materials).

The child looks at movement or shiny items but does not seem interested in stable objects. (Movement)

  • Materials in morning meeting must meet this assessed need for movement of the presented materials to foster visual use. Shiny items are considered under the Movement characteristic since the reflected light from the surface looks like movement. Movement should be gentle and slow not fast and frantic.

There is no or little reaction to visual threat or touch between the eyes. (Visual Reflexive Responses)

  • Reflexes are reflexes and cannot be taught. There are no accommodations for visual reflexes.

The child fixates briefly but likes light, ceiling fans and movement. (Light gazing and Movement)

  • To foster looking at the presented morning meeting materials, light must be controlled, limiting the child’s lightgazing.
  • Because light is important to encourage looking, light the materials that are presented or use materials that light up.
  • Because fixation is brief, the material must be presented for longer so the child has another opportunity to visually locate.

The child sees things in the peripheral fields but does not react to items in central vision positions. (Visual Fields)

  • Because peripheral fields are stronger than central visual fields, the materials must be presented off center in the best assessed lateral visual field. (The child in Phase I will have a distinct preference for one lateral visual field).
  • The lower visual fields are often not functional well into Phase III so eye level is recommended. Upper fields can also be inaccessible.
  • Make sure the “action” of morning meeting is within their best assessed visual field.

There is visual attention in near space only within 2 feet. (Distance and Complexity)

  • The child can only look at items in near space. The exact assessed distance needs to be respected and materials presented within this distance. At this Phase, this is typically within 18”-24” of the child’s eyes.
  • Give the child a copy of the material being used with other child in turn. This provides visual access for the child even when materials are being presented to other children at greater distances.

The child rarely looks to faces (Complexity).

  • Faces are very complex. This child will have difficulty looking at faces. Be mindful that the child may be attending but not able to make eye contact or even look towards your face if you are talking. Greet them with your name and tell them what you will be doing with them. Call their name before delivering a message or asking a question. Research shows that adults often do not talk as much or as long to children without eye contact. Adults should be aware of this and monitor their behavior with children.

The child sees best in uncluttered, quiet places. (Complexity)

  • Provide quieter environments
  • Create morning meetings of less children so the movement, visual complexity and auditory complexity is more controllable. There is no rule that morning meeting needs to be all the children in one morning meeting. Have several smaller meetings.
  • Provide non-complex backgrounds for all learning materials.
  • Where non-complex shirts. You are the the visual background!
  • Seat yourself in the same position as the child to see what the child sees. You will be surprised how much visual complexity you will notice and need to control.
  • Position this child solidly for best visual skill use.

The child only looks at familiar and favorite toys. (Novelty)

  • Use familiar materials.
  • Use consistent materials to build visual familiarity.
  • Predictable routines in morning meeting will support visual recognition of materials and help children predict the sequences.

The child has a long delay before they turn to look. (Latency)

  • The child will have latency for looking and latency for understanding what is seen. Using the assessment and taking data will help identify how long the child requires for visual attention, which visual field is faster and which visual field has the most sustained visual attention abilities. The material needs to be where the learning is accessible and for as long as the child requires.

 

Toys for the Holidays

As we think about gifts for our children with CVI, we want to pick toys and materials for fun and learning. First and foremost, children with CVI are children. All children benefit from play as the basis of their learning. It is essential that our children have those opportunities carefully created and frequently available. Think about a child with typical vision. They have access all the time. Wouldn’t it be great to have teams look across the child’s day and make sure our children with CVI have visual and play access all the time?
These play opportunities need to be matched to children’s assessment results from the CVI Range (Roman-Lantzy).
Certainly for children in Phase I and Phase II, as measured on the CVI Range (Christine Roman-Lantzy 2007), toys and materials that would be best would include:
• A toy that includes the child’s favorite color as a component in a less complex toy surface.
• Lighted toys
• Movement that is predictable, not too frantic.
For the play environment:
• We want fewer toys to look at matched to their assessed tolerance.
• We want non-complex backgrounds so the toy really stands out.
• We want the toy to be in the child’s best visual field at eye level.
• We want toys close matched to their visual abilities for distance.
• We want an activation method for the toy. This might be a switch that the child can accidentally hit, learn and then purposefully hit. It might be a toy that makes a visual change or a toy that makes a noise when it is hit. Children in Phase I might not be reaching much yet but we need to present the opportunity to activate to build reaching. Far too many toys for children with CVI rely on passive looking and no expanded access ability for the improving vision and visual motor skills.
• We want toys within the child’s arms’ length and arm movement abilities. If the child has limited arm movement, we must place the activation method near the hand/arm and have another part of the toy within their visual field (“I move my arm and I see this visual event”).

Supporting Understanding of the Auditory Environment

Children with CVI have difficulty seeing things at distance. They tend to be “close lookers”. This can last well into Phase III as measured on the Christine Roman-Lantzy CVI Range 2007. If they do look to distance events, they struggle to understand what they see. Interestingly, when children do begin to look for sounds sources, they tend only search for familiar sounds from visually familiar materials. They don’t seem to even try to look for the sources of unfamiliar sounds from visually unfamiliar materials.
In learning environments at home, in the community and at school, students are surrounded by sounds. Students with typical vision hear a sound, turn to look for the sound source and determine whether there is a threat in their environment. They alert, find the sound source and return to activities, regaining attention to learning.
Because children with CVI lack this ability to checkout the sound, to checkout whether there is a threat or not, we need to carefully support and build that environmental sound understanding. Only then can they return to learning. We want to connect their visual and auditory understanding of their distance environment through planned exploration at near.
This is a statement I include in all my IEPs under methodologies:

“Support Susan’s understanding of environmental sounds by bringing sound sources to her, by traveling to the sounds to explore them and by interacting directly at near with the items that are making sounds. Allow Susan to make the sound if possible to connect the visual information to the auditory event”.
Example: If the door slamming made the noise, have the child slam the door themselves. Verbally label the object, the door, and the action, slamming. Later when slamming door happens, it can be identified and labeled.

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).

img_1580

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)

Ultra Thin Lightbox

I need backlighting for my students with CVI so much of the time. I was frustrated by the cumbersome American Printing House lightbox for certain adaptations to the curriculum.  I just ordered one of these very thin light boxes for my students from Amazon. This one is just great. The “plug in” one is $39.99 but you are tied to a computer USB port or plugged in the wall. The rechargeable version is $79.99 and has the benefit of portability. It is extremely lightweight. I so appreciate light weight as I travel to multiple schools! Image the ability to take this everywhere in the community to support visual skills!

https://www.amazon.com/Huion-Rechargeable-Artcraft-Portable-LB4/dp/B00JXFYL80/ref=sr_1_1?ie=UTF8&qid=1477420006&sr=8-1-spons&keywords=rechargeable+light+box&psc=1

 

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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.