Visual Experience, Joint Attention and Salient Features

I went to a wonderful workshop this month with Dr. Roman-Lantzy. The topic was “Assessment and Strategies for Children in Phase III” (as measured on the CVI Range Roman-Lantzy 2007).

Some of the many things we talked about included:

  • Visual inaccessibility at distance for children scoring in Phase III (CVI Range Roman-Lantzy 2007)
  • How vision, cognition and language are linked.
  • How joint attention in typically developing, sighted children helps build these visual, cognitive and language skills.
  • How vision, cognition and language skills are based on the child’s experience.

It got me thinking about my own daughter’s visual, cognitive and language development. She was a typical developing toddler with full visual access.

We lived on our sailboat in Boston Harbor. We were surrounded by ducks daily. My daughter would see these ducks everywhere, everyday. (visual experience)

When she looked at or pointed to the ducks, we shared gaze to the ducks and I would label this animal: “Duck” (shared gaze, language)

As she language skills grew, she would begin to point and label them as “Duck” as well (building language and shared gaze).

When we traveled on land, she began to label other animals as ducks. She understood that dogs, cats and other birds we saw were not human but animals (cognitive). She over- generalized that any animal that was not human was a “duck”.

Sharing her gaze and sharing her experience, I pointed out the salient features that made these other animals different and labeled them as different. “No. That is a dog, he has 4 legs and is furry”. (cognitive, shared gaze and salient features).

Very soon, my daughter was able to use her cognitive comparison skills to label each animal she saw with the correct name based on the visual salient features: shape, number of legs, how then moved, where they lived, how they sounded.

For children in Phase III, supporting children’s visual, cognitive and language skills must be carefully planned, based on experience and presented at near by providing supports around salient features. They must be presented in planned, accessible ways due to the inaccessibility of distance events and materials.  This link must be facilitated to build visual, cognitive and language skills by comparing and contrasting visual attributes that are experienced, highlighted and shared.

Importance of Color

So many times I see professionals mark the CVI Characteristic of “Color” as “Resolved” as soon as a child looks at more than a single favorite color. (Roman-Lantzy CVI Range 2007).

This is a great misconception. Marking the Color characteristic as “Resolved” means that color is no more important to the child than to a typically developing peer. (Roman-Lantzy)

Color remains important for many children assessed much higher in the CVI Range. I recently assessed a child in a typical kindergarten. Careful interviewing of parents and his team plus observations and direct assessment uncovered this important information about this child’s color preferences:

Parent/Team Interview (Roman-Lantzy):

  • This child’s parents immediately report “red” as a favorite color. He always picks red clothing, red toys and wants to paint his room red.
  • This child’s teacher immediately was able to state that “red” was this child’s favorite color. When I asked this teacher whether he knew the favorite color for other children in the class, the answer was “no”. (This color preference for this child with CVI was strikingly evident for a teacher with 14 other students in the class!)

My observations and direct assessment revealed:

  • This child looks at all colors and colored patterns.
  • This child does have a distinct preference for the color red for visual attention at near and distance.
  • This child was observed visually locating and then following a peer dressed in red or orange when told to line up, when evacuating the building in a fire drill and when outside on the playground.
  • Told to pick items for decorating a snowman in Art, this child walks completely around the table to chose a red ribbon for the scarf.
  • Walking the hallway to Art, this child was observed to have increased visual attention to red items in the hallway on all planes (materials on the floor, wall, above to the red Exit signs and to children dressed in red walking by).
  • In the Speech session, this child picks red pirate game piece and has great sustained visual attention to the red, lighted spinner.
  • Asked to pick a marker for an activity, this child picked the red marker every time.
  • Asked about a bowl choice, he asked for the red one.

If we know this child has such a strong color preference, we can infuse this color into activities that are difficult for him:

  • Added to the locker hook to hang up his coat
  • Added on the classroom sign-in sheet to highlight where to place his name.
  • To draw his visual attention to salient learning features.
  • Added to the envelop edge to help him place the paper into the folder.

Missing this vital information about color, misses a great learning accommodation for visual functioning.

 

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

 

Perkins School for the Blind CVI Symposium April 7, 2017

Spread the word about this important event! It filled very quickly last year so sign up if you are interested.

CVI Symposium: Best Practices and Current Research presented by experts in CVI

Held at Perkins School for the Blind in Watertown, Massachusetts

Friday, April 7, 2017 8:30 sign-in, presentations 9:00-4:30 

$100.

6.5 ACVREPs, 6.5 PDPs, 6.5 CEs

There will be discussion about current research and best practice related to brain-based visual impairments.

From the website:

Topics and Presenters include: (with more to be confirmed)

  • Visual Processing and the Impact of Damage: What We Know and How We Know

Lotfi Merabet, O.D., Ph.D., MPH

Presenter TBD

  • Collaborative/Coordinate Care – The Importance of an Effective Team

Anne Fulton, Ophthalmologist

Rebecca Davis, parent

Ellen Mazel, Ed., CTVI

  • Literacy and O&M from Phase I to Phase III

Christine Roman-Lantzy, D.

Matt Tietjen, M.Ed., CTVI

Find out more at:

http://www.perkinselearning.org/earn-credits/onsite-training/cvi-best-practices-current-research

I believe this will also be available to watch after the symposium.

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

Color Highlighting: Luggage Handle Wraps

For color highlighting, I can’t always use my favorite colored duct tap to help students with CVI to visual locate and understand where to grab/where to hold for best access. I found these removable red luggage handle wraps that quickly and easily can be applied to provide that access. In the pictures here in the community, my student who locates the color red best, is using the red luggage handles on a shopping cart in the store and on the bowling frame during a recreational activity. The extra benefit is that these handles have a unique, “squishy” texture that provides a tactile cue.

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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

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

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 from the CVI Range (Roman-Lantzy).
Certainly for children in Phase I and Phase II, as measured on the CVI Range (Christine Roman-Lantzy 2007), toys and materials that would be best would include:
• A toy that includes the child’s favorite color as a component in a less complex toy surface.
• Lighted toys
• 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. Children in Phase I might not be reaching much yet but we need to present the opportunity to activate to build 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”).