environments for CVI

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.

• A toy that includes single bright color. The multicolored nature of the toy surface can confuse the child. Single colors “hold” objects together visually and are easier to recognize.
• Lighted toys for those that love light
• Musical toys. We all love those!
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. There might not be reaching much yet but we need to present the opportunity to activate to build that 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”.  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).


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 presentation needs.

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!




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 around the well known visual behaviors of CVI.  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.


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 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.



Visual Motor: Where to Access the Bow Ends?

From my last blog entry, I mentioned that I highlighted the ends of a bow to help a student have visual access to where to grab to untie the bow.

I got a comment to that blog that I think would be great illustration of a misconception. Much thanks for the comment that allows me to clarify!

Here is the comment:
“Great idea to put a string on a book to be opened each time! Why not use a shoe string with plastic ends? You can get them in the buck store –like 6 pairs for $1.”

So why didn’t I use colored shoe strings for this? First of all, what is my goal? My goal is for the child to have a visual anchor to the bow ends, not the bow itself.  If I used shoe strings that are colored, the child still will not know where to grab. With the whole bow highlighted, reaching to the whole bow completely defeats the purpose: grabbing the end. I always think about what exactly I want the child to do. Where exactly to I want to draw visual attention? Where exactly do I want the child to reach to for function? I keep these questions in my mind every time I think about visual supports for students with visual impairments.

Teaching Staff About CVI Pays Off!

I complete CVI inservices to the educational teams every fall and throughout the school year as needed. One inservice helps teams understand the overall concepts about CVI and the other inservice helps teams understand the CVI assessment, the functional vision assessment results for each child. With this information, teachers and therapists understand CVI and understand their student’s visual needs. They can adapt toys and learning materials to meet those assessed needs.

Here is an example of a toy adapted by the speech therapist for one child’s assessed visual needs. It provides color support with red duct tape at the activation button. Pushing the button creates a light show!

This is a box of holiday lights but left in the box. It is available from Amazon.

string lights

string lights box

string light amazon


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 Assessment

All TVIs should become competent in the assessment of all the visual behaviors of CVI. There are just too many people not using brain based criteria for their assessment of children with CVI. If the brain based areas are not assessed 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 assessment 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 visual skills. 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. Each child with CVI will have unique educational needs based on their own individual assessment results.
  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 , has visual access to the better visual field, has an identified “wait time” for visually processing, has materials in the most accessible bright color and that color is considered to be a way the child discriminated and recognizes, has the light controlled and used optimally, has the motion distractions removed or movement used to draw visual attention, and has the complexity of the environment matched to the assessed needs.

  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.

Connecting Vision and Compensatory Skills


For my student, the personal identifier needs to be visually accessed on his left side, slightly above eye level.

I chose the red, furry fabric as his 3D personal identifier after his CVI assessment. The personal identifier is attached with Velcro so it can be removed and moved closer to this child. I can create movement to draw his visual attention. This student looks most reliably at the color red, to movement against a non-complex background, to materials within 12-18” and I know, from assessment, that he can’t access flat 2D pictures or icons. This personal identifier appears on all of this student’s belongings and locations (ADL box, locker, calendar system, etc.).

To approach his locker, he is positioned so the lockers appear on his better left side. Two identical personal identifiers are placed on his locker, one at eye level for visual access and one lower for tactile access as he trails the lockers with his left hand. Over time, this student is observed visually searching to the left on his locker after he encounters the tactile symbol. This visual and compensatory skills access supports his visual location, his anticipation of what he will see and connects sensory concepts.