Phase I

Phase I: Visual Affects

The child in Phase I may act like a child with total blindness. They might not locate or visually attend to much in their environment. This is not due to visual acuity but to the overwhelming complexity of the environment. They just can’t handle the confusing swirl of kaleidoscopic color and movement.  Because they behave as if they are ocularly blind, they are treated as ocularly blind. Their vision is never considered, assessed or programmed for. With this lack of visual challenge, they go on to develop auditory and tactile compensatory skills and visual skills lag behind.

One student I assessed in the past at age 11, acted in such a way. She felt for objects rather than looking for them. Once assessed using the CVI Range (Roman-Lantzy 2007), it was clear that presented with materials, given 20+ seconds, on the left visual field at eye level, with bright saturated colors against a non-complex background, this student did, indeed have useable vision. The educational team was present for the assessment and films shared with her parents. From that day forward, visual skills were considered, visual expectations appeared on her IEP, and visual skills improved even in two short weeks. She gained the gift of visual access!

Functional visual assessment using the CVI Range would have identified this sooner. She had only ever had an ocular functional visual assessment even though there was nothing wrong with this student’s eyes. The wrong assessment tool led to the wrong conclusion.

When you act visual impaired and are not assessed using the correct assessment tool, you will never gain visual access..

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Improving Vision: Partners in the Journey

I just signed up for this free webinar from Perkins eLearning

October 18th, 2017 11:00-12:00

This is a webinar presented by a TVI who is CVI Endorsed (Perkins-Roman CVI Range Endorsement) and a parent of a child with CVI. It will document the collaborative work of improving vision for a child with CVI.

Can’t wait to see it!

If you can’t participate at that time on that day, the webinar will be available after the session to view.

http://www.perkinselearning.org/videos/webinar/partners-journey-cvi-experience-birth-age-3

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.

The Expanded Core Curriculum (ECC) for Students with CVI

What is an Expanded Core Curriculum?

Years ago, students with visual impairments were educated in separate schools for the blind. Curriculum needs addressed everything for the student with a visual impairment both academic areas and specialized instruction that provided students with all skills to insure full independence in life. Students often lived at the school and instruction occurred across the day: self-care, moving safely in the environment, using transportation, safety awareness, social skills and recreation opportunities were embedded.

The education model shifted in the 1980s and students with visual impairments increasingly moved to inclusive programs in their communities. These inclusive programs could address the academic needs of students with visual impairments when adapted by a teacher of students with visual impairments. Something was missing. At the inclusive setting, inclusive schools were unprepared to address the other important learning needs for children with visual impairments. They never had to address these important areas because students without vision loss learn these skills incidentally by watching.

The Expand Core Curriculum is an essential consideration for all children with visual impairments including children with CVI. The nine areas of the Expanded Core Curriculum, if they are considered at all, are often mistakenly considered only for the academic child with ocular visual impairments.

Inclusive school settings teach the general education curriculum of math, science, English language arts, foreign language, gym, science, social studies and fine arts to their students. For students with visual impairments, the expanded core curriculum provides those essential independence skills needed for living and working. The expanded core curriculum is meant to level the educational playing field by providing instruction specific to the needs of a child with a visual impairment.

The expanded core curriculum, or ECC, should be used as a framework for first assessing students with visual impairments, then for planning individual goals and objectives.

The nine ECC areas that provide this specific instruction include.

  • Compensatory or functional academic skills, including communication modes
  • Orientation and mobility
  • Social interaction skills
  • Independent living skills
  • Recreation and leisure skills
  • Career education
  • Use of assistive technology
  • Sensory efficiency skills
  • Self-determination

Are these considered on your child’s IEP? We will look at each a bit more in-depth in later posts.

“Duckness: How Do We Know?

Look at this series of pictures. (From American Printing House for the Blind website)

How can very young children with intact visual skills understand that these are all ducks?

They understand “Duckness”.

They have a keen understanding of the salient features (Roman-Lantzy literacy) that make up this “Duckness” because of shared visual experiences with others and with access to pictures, TV and movies that feature ducks. This develops effortlessly for children with intact visual skills.  Without direct instruction, they understand that real ducks are different sizes, colors, and ages. They understand that ducks can be seen in different perspectives depending on where and how they are standing. They understand that ducks can be flat in pictures. They understand that ducks can be symbolic in toys, signs, pictures, colored cartoons and in black and white drawings.

Our children with CVI lack this visual access to “duckness”. They lack the expanded and repeated knowledge about ducks. If they have seen a duck, their idea of “duckness” is limited to that one duck. Due to reduced eye contact with people and with reduced eye to object abilities, adults do not explain the shared salient features that all ducks share.

As adults serving children with CVI, we should be aware of this limited access and limited understanding that can occur in 3D and 2D. We must create opportunities to expand children’s access matched to their assessed functional visual skills measured with the CVI Range (Roman-Lantzy 2007). We must evaluate all our materials with this visual access limitation considered. We must adjust our own interactions and instructions to include salient feature, comparative language (Roman-Lantzy).

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!

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.