improvements

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.

Seeing Movement

Here is an interesting video about a woman with a brain injury. As she recovered some sight, she is first able to see rain since it was moving. She progresses to seeing other kinds of things moving in the world. Movement is so important for some children with CVI!

Blind Woman Who Saw Rain

https://www.youtube.com/watch?v=9ABQ-U6V0tY

 

Brain Plasticity

I just attended a meeting where the school psychologist stated “This child’s skills have plateaued”. Such old and erroneous information! Even with the scientific evident to the contrary, some professional continue to propagate this brain science myth. This is a dangerous myth. It sets a mindset that lowers a team’s expectations for a child’s continued learning across all skills.

In schools, there continues to be a misconception that brain plasticity is fixed to ages between 0 and 3 years old. While it seems true that the young brain learns and reassigns best, this does not mean that after age three, we do not have the expectation for improvements for all skills including visual skills. The brain has great plasticity all through life so we must expect improvements or we will most certainly not get them! We must continue to provide each child with the needed supports. Of course, these needs are determined after careful assessment using the correct tools that measures where and how the child is functioning. For a child with CVI, the correct assessment for functional vision is the CVI Range (Christine Roman-Lantzy 2007).

Knowing where and how a child is functioning is the only way to provide first: optimal visual access and second: build visual skills. We move from current functioning, determine the next steps and create goals and objective for improvement. The CVI Range provides us with an assessment tool to measures that improvement.

Here are some resources that I shared with that psychologist, parents and the team:

Psychology Today: Brain Plasticity in Older Adults https://www.psychologytoday.com/blog/iage/201304/brain-plasticity-in-older-adults

Dr. Lofti Merabet Looking Inside the Adaptive Brain
https://videocast.nih.gov/summary.asp?Live=16959&bhcp=1

Inservice about Peripheral Vision

My students in Phase I and into early Phase II as measured on Christine Roman-Lantzy’s CVI Range, use their peripheral vision for looking. I struggled to help staff and parents understand exactly what this means as far as visual accessibility of learning materials for the child. I devised an inservice for staff and parents that simulates what kids see when they use peripheral vision. Using this, staff and parents can really live that inaccessibility.

I place people into teams of two. One person on the team is “has” CVI with only peripheral vision use (Phase I and early Phase II). I ask them to focus on a target in the room and not turn to look at any materials their partner will present.

The other team member shows their partner with CVI three kinds of learning materials in their peripheral field:

  • A 3D object
  • Pictures from a book
  • Communication icons
  • Words in large print

I ask the peripheral vision user to tell me what they can see during each presentation. It becomes so clear that using peripheral vision, the child can only see color and vague shape.

This inservice, yet again, gives me an opportunity to talk about the child’s assessed functional vision. I have the opportunity to again stress the possibility of improvement for children with CVI. Working with accessible learning materials with environmental adaptations matched to the child’s CVI Range results (Christine Roman-Lantzy 2007), will build visual skills towards that ventral stream use that we all want for the child but for now, these kinds of learning materials are inaccessible.

The inservice provides the experience of inaccessibility.

Phase III: Continuing Visual Needs

Looking at the Christine Roman-Lantzy CVI Range (Roman-Lantzy 2007), Phase III is measured as 7-10 on the Range. What visual concerns are still effecting learning? Only careful assessment using the CVI Range (Roman-Lantzy) and the CVI Extension Chart (Roman-Lantzy) can identify these needs.

  • Latency for understanding: students may still need extra visual exploration time to understand what is seen especially the flat 2D literacy materials and symbols and at distance.
  • Students benefit from the support of salient language and labeling that capitalizes on auditory skills to support visual recognition.
  • Lower visual fields might still be effected in Phase III and should be assessed to ensure safe movement through the environment.
  • Visual novelty still effects visual recognition. The student benefits from having newer learning based on the familiar materials. Presenting new materials to teach new learning presents an extra challenge that might impede learning.
  • Complexity of all kinds effects children in Phase III: complexity of array, sensory complexity, facial complexity and complexity of backgrounds, still might limit access to learning and social information.
  • Distance learning requires support because these students are often “close lookers” and lack typical visual curiosity at distance.
  • Although lightgazing may have disappeared as a visual behavior, children benefit from backlighting for 2D understanding and other learning.

Youtube Lecture: Recovered Sight: Michael May

Understanding Blindness and the Brain (Brian Wandell, Stanford University)

I think you might find this one fascinating! Michael May lost vision as a child and regained it in his 40s. As he regains sight, there are so many CVI characteristics he experiences!

https://www.youtube.com/watch?v=VVgfC_FV2hI

Learning about the Brain

In college, learning to become a teacher of students with visual impairments, I learned all about the parts of the eye and how each part functions. I learned about various types of eye damage and what kinds of visual impairment that damage might cause. This helped explain the student’s functional vision to create the optimal environment for learning.
For CVI we need to do the same for the brain: understand the parts of the brain and to understand how each part of the brain functions (as currently understood by vision neuroscientist). Hopefully in the future, we can understand how that damage causes certain kinds of visual impairment.
For now, we assess child’s visual functioning by using assessment based on visual behavioral characteristics on the CVI Range (Roman-Lantzy 2007). This helps me explain the student’s functional vision so the team and parents can create the optimal environment for learning and to measure visual improvements that are expected.

Reducing Support

In the last blog post, I talked about a strategy using a lightbox to support looking and reaching to access finger food for my student Julie. She was reaching without looking to eat and she was satisfied with that! Her self feeding is certainly functional but not helpful as we more to the future goal of utensil use. The higher level skill of utensil use requires looking to the food using central vision using a fork or spoon.

At first introduction using the lightbox backlighting and the clear plate with popcorn as the visual target, Julie had immediate access.  Her improved skills for looking and reaching with this environmental support of backlighting was fantastic.  My goal is always to provide access for current skills after assessment using the CVI Range (Christine Roman-Lantzy).

This can never the last step.

I am always thinking about improvements in Julie’s skills using less environmental support. As Julie improves her visual motor skills while finger feeding, I will use the brightness adjustment feature of the lightbox to reduce the backlighting gradually until the lightbox itself is no longer necessary for finger feeding.

We are not there yet, but I would expect when we introduce spoon or fork use, we might need to put the backlighting support back into place as Julie learns a more difficult skill, while she tolerates hand under hand tactile support (complexity) and moves to greater independence.

Improved Visual Motor: Self Feeding

From our assessment using the CVI Range (Christine Roman-Lantzy) we understand how important light is to Julie, age 10.

Julie enjoys eating and will finger feed completely without looking.  She finds the food using her tactile skills only.  It will be impossible to move to increase her eating skills using a fork or spoon if she is not looking at the visual target of the pieces of food.

When the lightbox is used with a clear plastic plate, Julie alerts, looks to the pieces of popcorn and sustains gaze while looking and reaching!  Her reach is direct, targeted and accurate to the popcorn. Just wonderful to see this immediately!

JA lightbox

(We ordered a large, clear plastic tablecloth that we can cut up to protect the lightbox).

Lightbox available free through American Printing House for the Blind if your child is registered as legally blind.  Ask your TVI to order it for you!

Embedding Strategies Throughout the Child’s Day

Strategies for CVI simply must be embedded into all activities of the child’s day.  There is no such thing as “Vision Time”.  I do see students for direct service but that is to know and understand them, to make a relationship with them and to continuously assess their vision skills. If I do not consult with the team and parents and infuse the needed strategies throughout the day, there will be no progress.

When I am talking to teams and parents of children with CVI and discussing embedding strategies for CVI into the entire day, I use the analogy of learning to play soccer.  If, when trying to learn to play soccer, a child only had one hour per week with me kicking a ball back and forth on an empty soccer field and kicking a ball into an empty soccer goal, the child would certainly learn some elements of the game of soccer.  The progress for learning these elements would be slower and muscle memory for actions would be weaker. That learning would not translate well to a real soccer game with multiple players, complex array of movement and sound, and multiple distractions.

If I practiced these skills everyday in a soccer routine-based routine, the skills would be stronger, more functional for a soccer game and skills learned quicker. The same is true for building visual skills. Practiced everyday, all day, in predictable routines, vision skills will be stronger and grow quicker.

Using strategies matched for a child’s distinct visual needs (as measured on the CVI Range Roman-Lantzy) within daily routines is the only way to provide access to the learning, to practice the access with familiar materials and events, to build function and to connect that function with generalized skills.  Visual pathways are strengthened with use. Strengthened pathways connect with other pathways to ensure generalization of skills across environments.

Phase I: Goal: Looking: Placing materials with the favorite color at near within the child’s visual field at all times through the day on materials that appear again and again in routines, will build an understanding of the material’s function. “I see that red spoon coming, I smell food. This red thing is a spoon”.

Phase II: Goal: Vision with function: Placing materials of favored colors at near and moderate distance within the child’s weaker and stronger visual fields at all times through the day on materials in routines, builds faster visual connections between events, materials, environments and people accessed daily. “I see Ellen in the yellow shirt at 4 feet, I hear the drawer opening, I hear the microwave, I smell my oatmeal, I am going to eat”.

Phase III: Goal: Resolving characteristics: Using familiar layouts for materials for my newer learning, allows me to learn the task rather to need to learn the new layout materials and the new task. (think about a math lesson introducing subtraction.  Best to use the Unifex cubes (familiar materials) that we used for learning addition.