Reading for a Child with CVI

Please watch these important webinars about teaching reading to children with CVI. Pay especially close attention to the fact that the methods are not uniform. They are in consideration of the visual behaviors of CVI of individual children. No reading approach is for every child. That “visual brain” and that “reading brain” are different in every single child.

The first webinar is by a parent of a child with hemianopsia, Monika Jones of the Brain Recovery Project. Although the webinar is not about reading specifically, there are some important considerations for reading presented. Those reading considerations match the visual abilities of the children with CVI impacted by this brain based visual impairment.

https://www.perkinselearning.org/earn-credits/self-paced/vision-after-occipital-lobectomy-and-related-surgeries

The next two webinars are by Judy Endicott. Judy is the grandmother of a child with CVI. Using her expertise in reading and her building understanding of CVI, Judy embarked on a journey to teach her grandson to read. What I love is that Judy was wonderfully diagnostic of her grandson’s abilities and needs.  Her approach to teaching reading followed her grandson’s lead.  She developed each step in the reading journey based on his successes and difficulties. If something didn’t work, she moved on to try something else in partnership with her grandson. Like any great teacher, she has understanding of the different developmental levels of learning, how the child with a neuro-typical brain learns, and that all learners have individual abilities that require instruction matched to those abilities and needs.

Part 1:

https://www.perkinselearning.org/videos/webinar/our-cvi-literacy-journey-phase-iii

Part 2:

https://www.perkinselearning.org/videos/webinar/our-cvi-literacy-journey-phase-iii-part-2

Valuable CVI Awareness of “Mistakes”

Awareness of the unique visual behaviors of CVI can provide teachers, parents and other service providers with context and understanding when learners with CVI make “mistakes”. I put “mistakes” in quotes because the “mistakes” that learners make will always allow us to understand their visual perception of their world if we consider them in the context of CVI. Matt Tietjen’s What’s the Complexity Perkins Elearning online class helped me to think more deeply about these visual “mistakes”.

Images in literacy materials in the community and at school are supposed to add information that supports the text or the situation.

This map symbol confused rather than supported my student’s understanding.

Seeing this icon on a subway wall, my student asked why there was a picture of a purse on the wall. This allowed me to understand the inaccessibility of this highly symbolic image of this map icon. It helped me understand how the student completely missed details in this image. It helped me understand how my student only really understood the shape of this square image and because he visually understands that purses are square shapes, he mistook this for a purse. “Why was a purse on this wall?”  “Am I missing something?” he wondered aloud.

Seeing this icon in a library book, another student identified it as a “flower”

Once again, the highly symbolic image was not understood. The student only perceived the shape not the meaning that the icon was supposed to provide. The “mistake” was made due to the impact of CVI on the student’s functional vision. The “mistake” helped remind me of the inaccessibility of highly symbolic images and helped me to remind me to always ask Matt’s question “What do you see?”

These two students can verbally communicate through their “mistakes” to help me understand how they see the world.

For our students with non-traditional language, we need to also diagnostically consider their “mistakes”.

In an assessment, it was clear that another student who is using a communication device understood the green “yes” symbol and the red “no” symbol when answering questions regardless of where the symbols appeared on the device page of 6 symbols.

I swapped out the red and green symbols for completely different symbols that were also colored green and red. The student continued to answer questions “yes” and “no” by hitting the “wrong” symbols based on color seemly with no awareness of the icon’s details and icon’s shape information.

 

  

 

 

 

 

It was so important for me and for her speech therapist to understand the reliance on color when using the device so color is considered when adding any newer icons.

“Mistakes” are a window into how student understand their world and how they function in their world. Without understanding CVI, these mistakes could be thought of as cognitive lack of understanding rather than the reality of visual inaccessibility.

Troubling Misuse of Promising Practice

When a new approach to teaching learners with CVI is suggested, we need to ask ourselves:

• Does this match our understanding of the unique learner’s visual behaviors?
• Is there scientific research to support the use of this strategy?
• If there is no scientific research, is it a “promising practice” that we can carefully try and carefully apply to each unique student’s situation?
• How do we decide to use this “promising practice”?
• How do we use it as it was meant to be used?
• How do we evaluate its effectiveness since not all inventions will be useful for all learners? (I hope the words collect data popped into your mind here!)

Recently I visited a school to consult for a student who was barely using any central vision to access literacy. The TVI had learned about word bubbling in a conference. Word bubbling is a promising practice suggested by Christine Roman in her book Cortical Visual Impairment: Advanced Principles.

This TVI took the app for word bubbling and suggested that all the child’s literacy materials were bubbled.

• This does not match the student’s visual skills. Central vision use would be essential for this intervention.
• This is not the suggested practice from the text: Cortical Visual Impairment: Advanced Principles.
• This was randomly applied with no diagnostic evaluation of the tool as applied to the student.
• The TVI never partnered with the reading specialist who would be the expert about the teaching of reading. That collaboration would be essential.
• There was no data on the effectiveness of this strategy for this unique learner.

Here is just one example of a sentence this poor student is now struggling visually recognize. I couldn’t quickly read it and I have good reading skills already developed.

 

Please:

• Understand your student’s visual behaviors.
• Try promising practices with careful consideration of those visual behaviors.
• Use the strategy as it was meant to be used.
• Collect data on the effectiveness of your trial. (Baseline data then progress data)
• Random application of any strategy is as inaccessible as doing nothing..

The Neuroscience of Reading

As people suggest methods for our children with CVI to learn to read, I wondered what does the brain need to do in order to learn to read?  I found a local researcher, Maryanne Wolf of Tufts University who wrote extensively about the neuroscience of reading in her book Proust and the Squid.

As it turns out, the brain needs to do quite a lot. It certainly requires a high degree of sustained visual attention, which can be problematic for many of our children with CVI.

Reading requires the whole brain including the occipital lobes, parietal, frontal and temporal lobes. The brain needs activation in both hemispheres and needs the “language areas” of the brain to be engaged and active. There are steps to reading function from decoding to understanding what is read. This reading “thing” is quite complex which is no surprise given how complex the brain is!

When we apply reading methods for our students with CVI, we need to apply methods to the child not decide that all methods work for everyone. We need to be diagnostic. What is working? Why is it working and under what conditions? Is it working at all? What can we do to improve this complex process that includes learning to use vision and to build reading skills?

No one of us serving students with CVI can know everything. We can certainly educate ourselves but will not be experts in everything. We must seek out and collaborate effectively with experts. In this case of reading, we need to partner with reading specialists as we apply any techniques for learning to read.

One size will not fit all because every brain is different and learns differently.

 

 

Supporting Language for Visual Attribute Understanding

In the CVI world there is great emphasis on understanding visual attributes to support for children with CVI. This is the consistent visual description language based on experience with objects with those attributes 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 visual attribute 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 visual attribute 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 visual attribute 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 visual attribute 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, visual attribute 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.

Visual attribute 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

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

Using Color Highlighting Effectively for Students with CVI

Color is such an important tool to use for students with CVI in all Phases (Roman-Lantzy).

In Phase I, color can support initial visual location using the student’s preferred color. Identifying that preferred color in assessment can be the key to building more functional vision

In Phase II and III, carefully use of color highlighting can facilitate vision for function. Color highlighting in these Phases will help support understanding of where materials are in space, where to place materials and where to reach to grab effectively. It can be used to draw visual attention and to support discrimination using highlighting of salient features in communications systems and literacy. For Orientation and Mobility, color can support distance attention and understanding. Color highlighting must be well understood and well applied for the optimal benefit when building student visual learning.

Check out this Perkins E-Learning Teachable Moment I recently did to learn more!

http://www.perkinselearning.org/videos/teachable-moment/color-highlighting-children-cvi

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 23^rd to December 10^th, 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

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 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 assessment 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 assessment 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 assessment 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. 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.