How Does This Make Sense?

The child has limited visual attention. He does not look at many items and the looking is very, very brief. The child enters school and icons, that very symbolically represent materials, are chosen to be used for his communication system.  How does this make sense?

• The child is not looking at 3 dimensional things in their environment therefore can’t build visual recognition of real 3D items. The can’t see the backpack and jacket in real life and recognize them. On the device, these icons appear. They are 2 dimensional and represent these things. How is the child expected to connect the 2D symbol to an 3D item they can’t look at and can’t recognize??

• This child is very visually impaired yet pictures are used??
• The child, if they can locate items, can only tolerate looking at a 3 dimensional item one at a time, yet they are presented with a HUGE amount of symbols on a communication system.

• The child can only look at items that move yet symbols are presented as stable items??
• The child is constantly told to “look” using central vision, yet it is their peripheral vision which is the most functional.
• The child is presented with 2 dimensional pictures the represent part of an object (which they can’t recognize in 3 dimensions!). I had to struggle with this one below.

Teachers of students with visual impairments who understand CVI and how to assess CVI must work hard to help teams understand this disconnect. Without the vital information gained from the CVI assessment of functional vision, the communication device materials and other 2D learning materials are inaccessible. Would we ever do this to a child with an ocular impairment?? I don’t think so!

MRI: No measure of CVI

Like it or not, CVI cannot be diagnosed with a medical test.  I sure wish it could be!

The MRI can be completely normal and the child can still have CVI.

The MRI can show huge brain structure changes and the child does not have CVI.

The MRI only sees changes in structure NOT visual functioning. It cannot diagnose CVI.

CVI cannot be diagnosed medically with any available medical test.

Another condition that cannot be diagnosed medically is autism. Both CVI and autism are diagnosed by looking at behaviors.

Good doctors see these behaviors, ask parents about these behaviors and diagnose CVI or autism.

It is great to get a diagnosis from the doctor for CVI but for assessment of visual skills, assessment of the brain based visual skills it the only criteria for assessment. With the complete assessment, you have accurate information for creating environments and optimal educational programming to help foster possible vision improvement.

Learning Media Assessment

The teacher for students with visual impairments should conduct a Learning Media Assessment on every child as part of any functional visual assessment. This LMA assessment carefully looks at a child’s ability to access print, symbols and learning media at near and distance. It might recommend that your child with CVI access materials using tactile and auditory media. This might be true but I would never leave print out for a child with CVI. I would build visual skills for literacy using color highlighting and use Braille as well if warranted.

I know of one student learning Braille at a high literacy level while she also builds print understanding using large print, bold green font with red highlighting. This is the best of both worlds!

The National Braille Press provides free materials for children and families to learn Braille.

From their site:

• An age-appropriate print/braille book for three age groups: birth-3, 4-5, and 6-7 in English or Spanish;
• A braille primer for sighted parents entitled Just Enough to Know Better;
• A tactile ball (red bags only);
• Print/braille bookmark;
• Print/braille alphabet card;
• Because Books Matter, a guide for parents on why and how to read books with their young blind child;
• A tactile maze or flag;
• Wikki Stix, a product that allows a child to make tactile pictures (blue or green bags only);
• A gift coupon redeemable for another print/braille book or braille/large print playing cards;
• Tactile Alphabet Letters sheets, showing upper- and lowercase print letters in raised-line format, and braille letters (blue bags only);
• A Braille Caravan block;

A description of the program on DVD.

http://www.nbp.org/ic/nbp/programs/readbooks/readbooks.html

Assessment Results and Program Planning

After careful assessment, the results provide us with numerous strategies for improving visual skills. This does not mean we get struck and only provide one kind of stimulus. For example, in a recent assessment of the attention to color, parents, caregivers and therapist mentioned the child’s preference for red and yellow. In my direct assessment using large pieces of shiny fabric, I confirm this is true in both lateral fields. With latency, the child does look at both these colors with 2 minutes. I then presented green to the right and left lateral fields and waited 5 minutes for the child to look on each side.   There was no looking to this green shiny fabric.

I set the child up in an active learning activity area with the green fabric draped up on his right, slightly touching his right hand to create familiarity with this color. The child makes accidental movements that cause the fabric to move. The shiny fabric is also reflecting light that increases the appearance of movement. Within a few days, this child is moving this fabric purposefully building increased color skills, understanding how his body is connected to the outside world, and building right field skills.

Color is such an important support for children with CVI to visually attend and to recognize. Just because there is greater or faster attention to some colors, this does not mean other colors are not accessible. If fact, if you make all objects the same color for a child, you are interrupting their reliance on color to figure out and distinguish one item from another.

CVI Assessment Kit

I’m off to see a new child this weekend and want to bring materials for assessment.  Top on the list is the parent interview.  Parents have all the answers if you ask the right questions!  Here’s a general list of items for a kit.  I will need to adapt this to the child I meet:

• Child’s favorite toy (ask ahead)
• Materials similar to the favorite toy in salient feature
• Visually simple toy that can be activated to create noise.
• One yard of fabric of favorite color and other colors
• One yard of shiny fabrics of each color
• Flashlight
• Plain black backgrounds: invisaboard, All-in-One boards, black placements or black fabric
• Slightly complex backgrounds
• Very complex backgrounds
• Childs favorite small finger foods (Cheerios, M&Ms, veggie sticks, cookies, fruit)
• Child’s favorite cup or spoon
• Plastic slinkys of different colors
• Set of pom poms of 6 different colors
• Set of balls of 6 different colors (can roll to see distance sustained attention)
• Black and white toys
• Bubbles for blowing
• Measuring tape
• Large mirror
• Suspended moving toy: windsock, spinner, pin wheel
• Small Lightbox, Lightbox app on the IPAD
• Clear or colored translucent items for the Lightbox
• Sets of red or yellow objects to be sorted into containers of red or yellow.
• CVI Complexity Cards (laminated so you can use food on top)
• Lights with colored caps or colored fingerpuppets.

 

 

Guiding Principles

I just love Dr. Roman-Lantzy’s Guiding Principles for working with children with CVI!  They highlight professional practice, the need for assessment, the need to have the highest expectation for improvement, the need for precise planning and the ultimate respect for children!

Precision:

• You must use the CVI assessment to accurately  provide the environmental and learning supports to build visual skills.

Intentionality

• With assessment you must understand where the student is functioning and where you expect them to function next.  Dr. Roman says not understanding where you are going with your instruction is like a couple of people lost while driving: “Yes, we are lost but we’re making good time”.

Reciprocity

• Observation is of the ultimate importance. You must respond to the child’s cues.  Put yourself in the child’s shoes and always consider the environment.  When a child is unable to use their vision ask: How is the environment effecting this child’s visual functioning.

Expectation of Change

• CVI skills improve.  This is a central concept to your teaching.  Assessment must be accurate, interventions must match to the CVI assessment and the environment must support vision use.  As you reassess, make changes to encourage further building of vision skills.

Attention to the Total Environment

• Complexity of the environment is the major reason that visual skills are poor.  Provide the needed support so the child has access to the instruction at all times.

 

Understand CVI and CVI Assessment

I run into many parents, classroom teachers or teacher of students with visual impairments who ask me for ideas about educational programming for their children with CVI. The very first question is “Has a comprehensive CVI assessment been completed?” This would include the ocular assessment to rule out any ocular problems or to identify any refractive errors that might require glasses. Again and again the answer is “no”. Random supports are being used with children with no assessment, no planning and no focus.

This CVI Range Assessment is one assessment for the visual skills in children with CVI. It is not used as diagnostic criteria for CVI but as one important component to identify some important functional vision areas. Dr. Gordon Dutton has the CVI Inventory to look at the visual behaviors of CVI. The TEACH CVI Screenings provide three screening protocols for looking at visual difficulties of children with CVI.

Teachers of students with visual impairments who are serving children with CVI need training in CVI and need to join the path of continued learning about CVI. That valuable training should include understanding the brain, CVI assessments and how to create educational programming for a child with CVI to help with visual access, to build visual attention and to build visual recognition. Would a TVI serve a child with ocular visual impairment without understanding the function of the eye? With out understating how that eye problem impacts the functional vision?  Never! We couldn’t possibly make suggestions for educational programming when we don’t understand the child’s visual skills. How could we ever measure the possible improvements in a child’s visual attention and a child’s visual recognition? How could we ever create appropriate environmental and learning material supports? To not understand or assess these unique issues of brain based visual impairments is to not understand the visual needs of the child.

Doing an ocular assessment only, serves to give false information to the team and false information about the child’s visual skills.

If you are a TVI and you don’t understand how to do a CVI assessment, find out! I am teaching an online class at UMASS Boston about CVI that includes an overview the brain, of assessment of the visual behaviors of CVI and discusses some of today’s promising practices to support students with CVI. To set you on the path in learning, purchase these two books : Vision and the Brain by Dr. Gordon Dutton and Cortical Visual Impairment: An Approach to Assessment and Intervention by Christine Roman-Lantzy.