cortical visual impairment

Interesting Webinar

I found this lecture so interesting!  It is one hour long but worth the time.

Looking Inside the Adaptive Brain of the Blind

Dr. Merabet speaks at the National Institutes of Health in Washington DC about the team’s work on plasticity, ocular blindness, and CVI. As usual I have more questions!


Active Learning: Best Placement

sensory vest

Where are the child’s hands naturally?   For the child whose hands are near their body, create a sensory vest.  This is a purchased child’s cobbler apron.  I sewed white curtain circles in various places under where the hands rest.  I attached red bells on elastic cord.  The child begins by accidentally touching then purposefully exploring to create the noise.  Because the bells are attached with elastic, it can be pulled into view.  Great practice for fine motor skills, tactile and visual skills.  I like to make sure I create exposure to all kinds, sizes, weights and materials (wood, plastic, metal).  This is active learning!  The child can wear this an stimulate all the senses.  True learning!

Balloon Magic!


Balloon Magic

I love using shiny mylar balloons as visual targets.  They hang in a child’s best visual field for as long as needed to allow the child to location using peripheral vision and turn to look.  I can pick the color to support looking.  The balloon waves gently all the time giving movement.  I can make sure it hangs at the correct distance for optimal viewing.  I have tried tying the string onto the child’s arm or leg where the child’s own movements create a great visual event.  Kids figure out pretty quickly how to get the balloon to move!  If they struggle, you can provide hand under hand assistance to demonstrate.

Look at that!  One simple balloon can be the basis of building a child’s visual attention. The motion helps visual location. the attachment of the balloon in a predictable place allows the visual target to be present as long as the child needs.  Hanging it in the best visual field supports visual location. Allowing the balloon to be controlled by the child builds a child’s understand of their own abilities to create a visual event.

Great investment for a few dollars!  One classroom bought a tank to refill because they are so popular.

Please wait! I can do it!

Wait time or allowing extra response time is so important for children with CVI. The world can be such a fast moving place that children never have the opportunity to visually locate anything.

The educational team including the parents felt that six year old Amy did not understand her name.  I was able to take a video of Amy to prove that wait time must be allowed so she can hear her name then turn to locate the person calling her. I stood six feet away on her right side and called her name.

It appeared as if this little child was totally unaware of my interaction.

I called again.

It took Amy 32 seconds to turn towards me but she was still looking only using peripheral viewing.  (I want central viewing because this is the only way a child sees details or my face.  Peripheral viewing only gives the child a general shape, movement and color.)

Eight seconds later, Amy was able to look using her central vision! She continued to look at me for 9 more seconds.

I love capturing moments like this to share. A video is clear evidence of Amy’s skills. Now the team including parents, consistently give little Amy the time she needs. Because Amy is building this skill, 8 months later she turns to find people who call her name within 5 seconds at 9+ feet on the left and right!  I even see her following the movement of people in the room.  Fantastic and very exciting!

If wait time is not allowed for children with CVI, they will not build skills and begin to improve vision use.

*Unfortunately, turning when hearing your name is often listed in the cognitive assessments of children. We simply can use this kind of visual response related testing to decide what a child’s cognitive skills are!

Look and Reach to the “High Five”


We worked with a parent who really wanted their child to respond to other people when he was greeted.  Because the child was nonverbal we decided as a team to work on the “high five” (when a person greets you with a raised hand, you touch return the greeting by touching their hand).

We brainstormed and created this strategy to address this important parent generated goal. We greeted this young boy with a “Hi Jimmy” and showed him our hand in a red glove with shiny dots on each finger tip.  This supported Jimmy’s visual need that we uncovered during the assessment of his visual behaviors. Motion and bright color supported his visual attention. Soon with the predictable auditory cueing, Jimmy began visually locating the glove.  A bit later, with hand under hand support at first, Jimmy would look and reach to the glove to “high five”.

Mission Accomplished but wait…When children show improvements in skills with CVI, we want to remove the supports carefully.  We would remove the shiny fingertip dots and make sure skills remain.  Later we would remove the fingers of the glove and finally remove the glove all together.

Assess improvements the child is showing and remove the supports carefully to move this child’s visual and visual motor skills to the next level.

Find it yet?

Optical illusion lost cow copy

For those of you still searching your visual brain for recognition of this picture, I will give your brain some clues.

First I will orient it the correct way it appears in the world.   I will tell you to look for the “cow”.  Now you can limit your vision search to what you know about “cowness”. Can you now see the cow looking at you?  There are two dark ears near the top left and a dark nose near the bottom middle of the picture.  Because you know that the eyes are near the ears, you can easily see these.  You have the benefit of visual memory.. You have seen thousands of pictures of cows and real cows too.  Children with CVI can build these skills by exploring real items and then linking what they now know to what is seen.  The hallmark idea:  CVI can improves! With careful assessment of the visual behaviors, you create educational programming and environmental supports to build visual attention and visual recognition skills.  We don’t just hope for, we expect improvement because we don’t know an individual child’s capacities for visual change! We don’t know who will make changes and what kind of changes those will be.

What Do Children with CVI See?

(Click to enlarge)

Optical illusion lost cow

It can be so hard to explain what children with CVI see.  In fact, we really don’t know what each individual child with CVI experiences their visual world. That will be different for each child based on the location and extent of the visual brain involvement, the other areas of the brain impacted, the child’s unique visual experiences before and after the injury and the way that unique brain rewires. This picture is a good way to explain the difficulty with visual recognition that children with CVI have. It is not what the the world looks like to a child with CVI. In this simulation, you see all the colors of black and white.  You see each line and shading but your brain is searching its visual memory for what this image represents.  You can feel several CVI visual behaviors:

You are experiencing delay in recognition: its taking you a long time to understand this.

This is visually complex scene.

If you were in a loud environment, it would take you longer to find meaning (Sensory Integration difficulties).

If I asked you to look at this while balancing on a thin balance beam, you would take longer to understand the picture (Positional Complexity).

You want to hold this closer to your face to understand what it represents (Distance).

You have never seen this before so it is new to you.  Once you have understood it the first time.  It will take you less time to find it the next time. (Novelty/Visual Recognition)

This simulation is a great tool to use with teams to help them understand that looking does not mean understanding what is seen. This is one of the greatest concepts to convey to parents and school based team members.

I see my hand!

I see my hand!

To help your child become aware of their own hands, use a hair scrunchie on the wrist to draw their visual attention to the natural movement of their own body. Hand watching, typical of all children, is a developmental step children with CVI might miss. It is essential for hand use.