picture understanding

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.

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 in Phase III. 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.

What Do iPads Support for Students in Phase III

As discussed many, many times, the strategies for CVI must match the assessment results using the CVI Range (Roman-Lantzy 2007). We never can just randomly apply a strategy because it will not fit the functional visual needs of the child. If it does not fit the functional visual needs, it will not provide visual access and will not foster improvement of cognitive and visual skills.

With that reminder, I was asked about ideas for iPad apps for children in Phase III (Roman-Lantzy). Just providing a student with an iPad does not guarantee access. We need to assess the child, think about their visual needs and carefully use the iPad as a tool to provide that access.

What can be some general needs for students in Phase III?

Color: The student might benefit from color highlighting to draw visual attention to salient features of pictures and text. (Roman-Lantzy)

Light: Backlighting helps foster access to materials especially in 2D (pictures and text).

Latency: There is still a need for increased time for full visual exploration and full visual understanding.

Visual Field: Lower visual fields might be affected.

Visual Novelty: Presenting novel materials might requires salient feature and comparative exploration. (Roman-Lantzy)

Complexity: Complexity affects visual understanding in objects, increased arrays, of faces, and of the sensory environment.

Distance: Near information is more accessible. Distance curiosity is not typical so distance information is missed.

 

How do we want the iPad to support the student in Phase III based on assessed need?

Color:

  • Tools for color highlighting help support salient feature discussion in pictures and text.

Light:

  • Backlighting helps with understanding and easy of access to prevent fatigue.
  • Moving to 2D: taking pictures of their items in the environment and then providing the 2D on the backlighted iPad.

Latency:

  • Provides ability to capture images and videos for longer visual access time.
  • Capturing images can be reviewed as long as needed.

Visual Field:

  • iPad placement is flexible matched to child’s best visual field.

Visual Novelty:

  • Expanded understanding: Example: Here is one kind of mouse in the book but these are all the other kinds of mice.

Complexity:

  • Enlargement: for things at distance, for small items in complexity and for literacy
  • Overall ability to use settings and apps to reduce complexity of images.
  • Studying facial expression in photographs and videos: salient language of faces matched to voice (auditory). There can be instruction about facial expressions that match the auditory information.
  • Salient feature discussion in photographs and text.
  • Increasing spacing of words and sentences to reduce complexity of array.
  • Masking: complexity reduction with tools in Photos.

Distance:

  • Videos on the iPad: to bring information about events and concepts that occur at distance: Example: We are reading about giraffes. I think about providing a child with access to where that animal might live and how they move.
  • Access to distance classroom events: Examples: learning song hand movements for circle time.
  • Community access: taking photographs of signs and environmental materials that can be explored on the backlighted, near placed iPad.

“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).

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.

 

Picture Accessibility for Children with CVI

In my work with children, I am often asked about the accessibility of pictures, icons and line drawings as communication systems for children. I especially struggle to be an effective voice around accessibility when my children with CVI look towards pictures but never use central vision to actually “see” and “understand” those pictures. I try to support my opinions with inservice simulations about peripheral looking, as it only provides visual information about general color and general shape. To understand objects, pictures, ions and line drawings, the child must look directly at the image using central vision and shift to the picture’s elements to understand it. At MIT, there are several labs that study various aspects of visual processing. I found this book and ordered it on Amazon for $10. I am finding it so helpful!

Looking into Pictures: An Interdisciplinary Approach to Pictorial Space by Heiko Hecht

Powerpoint Books: Matching to Assessed Visual Needs

Literacy is so important for every child. I love making Powerpoint books for my students with CVI. You can make these for the class as a whole based on a thematic unit or make individual books tailored to each child’s visual needs and preferences.
Using Powerpoint books allows me to use strategies matched to the child’s assessed visual needs using the CVI Range (Christine Roman-Lantzy 2007)
Color: I use the assessed color preferences that I has discovered in my assessment.
Movement: I can insert slight movement as needed using an inserted film clip. I also like to insert films to build cognitive understanding. If the child will look at a plastic toy fish, I do not want they to believe that “fish” are hard plastic, non-moving things. I want to build understanding of how they move, where they live and to have the child understand that fish come in different colors and shapes. I can insert a film clip of fish in a fish tank. I can talk about how fish are alive, breathe, have different colors, swim in water and how they move. Children with typical vision have this information without direct teaching. I want my students to have the same access.
Latency: The images on the pages can stay present for as long as a child needs.
Visual Fields: The device using the Powerpoint can be placed in the best visual field. This is often at eye level.
Complexity: Powerpoint books allow me to choose a non-complex background for each slide page. If I take my own photographs or grab images from Google, I can Edit and erase all complexity before I insert the picture. If I take film, I can make sure that film is non-complex.
Lightgazing: Because the Powerpoint is created on a computer or backlighted device, the child’s need for light is satisfied.
Distance Viewing: The device playing the Powerpoint can be placed at the child’s assessed best visual distance.
Visual Reflexive Responses: No strategy addresses a reflex. This is a characteristic of CVI but not one we program for.
Visual Novelty: Children will look at familiar items better than non-familiar ones. Using pictures of familiar items and creating books about familiar topics, events or predictable sequences are much more likely to draw a child’s visual attention and interest. Remember that all children like predictable books!
Visual Motor: Visual attention is important for literacy but the ultimate goal is always independence to control the book and choice of books. With the ability to turn to the next page or to indicate a desire for a different book is often visual motor task. To encourage visual motor, there must be an access method that is matched to the child’s assessed visual skills to find and reach.

Here is a Youtube explanation of how to make the Powerpoint book https://www.youtube.com/watch?v=tYQCwowU8sk

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.

Understanding Color in the Brain

I always find it so exciting and encouraging when brain research about the visual system continues to unwrap the great mysteries of the brain. This understanding can only move us forward in understanding CVI and in assessing whether interventions are working. I am deeply interested in why my children behave the way they do. Here is a recent article from Spectrum MIT, a publication from Massachusetts Institute of Technology: http://spectrum.mit.edu/fall-2016/color-decoder.