I complete CVI inservices to the educational teams every fall and throughout the school year as needed. One inservice helps teams understand the overall concepts about CVI and the other inservice helps teams understand the CVI Range (Roman-Lantzy 2007), the functional vision assessment results for each child. With this information, teachers and therapists understand CVI and understand their student’s visual needs. They can adapt toys and learning materials to meet those assessed needs.
Here is an example of a toy adapted by the speech therapist for one child’s assessed visual needs. It provides color support with red duct tape at the activation button. Pushing the button creates a light show!
This is a box of holiday lights but left in the box. It is available from Amazon.
VISN 648: Cortical/Cerebral Visual Impairment
Class #: 14819
Instructor: Ellen Mazel
Course Description: This course provides an in-depth study of CVI and resources available for assessment and instructional strategies. Participants will further examine and explore the unique educational needs of children with CVI and the skills related to teaching these children in a full array of educational settings; Pre-K through grade 12. Topics include teaching strategies in the core and expanded core curriculums, such as: literacy, career-vocational skills, visual efficiency and compensatory auditory strategies. Instruction will also address material modifications and accommodations.
- Cortical Vision Impairment: An Approach to Assessment and Intervention
- Author: Christine Roman-Lantzy
- Copyright: 2007
- Available from: www.afb.org
Some children are assessed using the Christine Roman-Lantzy CVI Range and their visual skills are measured as operating in Phase I. Here is what we know about children in Phase I (Christine Roman-Lantzy)
- The child has great difficulty locating items in the environment and looking long enough to recognize them.
- The child lacks visual memory for items in their environment due to this limited looking.
- The child has a favorite color and will only look at simple one colored items. (Color)
- The child looks at movement or shiny items but does not seem interested in stable objects. (Movement)
- There is no or little reaction to visual threat or touch between the eyes. (Visual Reflexive Responses)
- The child fixates briefly but likes light, ceiling fans and movement. (Light gazing and Movement)
- The child sees things in the peripheral fields but does not react to items in central vision positions. (Visual Fields)
- There is visual attention in near space only within 2 feet. (Distance and Complexity)
- The child rarely looks towards faces (Complexity).
- The child sees best in uncluttered, quiet places. (Complexity)
- The child only looks at familiar and favorite toys. (Novelty)
- The child has a long delay before they turn to look. (Latency)
The child enters school and icons, that very symbolically represent materials, are used. How does this make sense?
- The child is not looking at 3 dimensional things in their environment. The icons 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 one 3 dimensional item 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!).
Teachers of students with visual impairments who understand CVI and how to assess CVI using the CVI Range must work hard to help teams understand this disconnect. Without the vital information gained from the CVI Range, 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!
We all pick up books based on our preferences for topics. Why should our children with CVI be any different? Parents have a wealth of information about what their children’s passions. These are the favorite and visually familiar things we should build our literacy materials around for our children.
My student is fascinated by cell phones. I grabbed a Google image of a cell phone (actual size) and chose a fairly complex book. I applied Velcro to the back of the cell phone image and to multiple places on each page.
The book became The Ten Ladybugs and the Cell Phone.
Because my student really likes this item and had a firm visual memory for this item, his success was almost immediate. Once he could locate the cell phone picture, he could hand it to me and play with a cell phone for a minute.
With this success, I can go several places with this skill. I can increase the complexity of the background and/or decrease the size so the cell phone becomes more symbolic (not the exact real cell phone size).
This makes learning interesting for my student and I can work toward my goals. We are both engaged and happy to work together! We move to increase and expand my student’s literacy interests based on their preferences not mine!
The teaching of salient features begins at birth. It should be a strategy suggested to parents and teams whether a child is in Phase I, Phase II or Phase III. In Phase I and II, we would be careful to limit the auditory distraction of salient feature discussion to before a child looks at materials and would support again after a child looked at the material due to the issue of complexity.
Incidental Use of Salient Feature Discussion:
Narration of the salient features regarded by the child becomes a philosophy of instruction throughout the day. This would provide salient language around items that a child can see at near and distance regardless of the CVI Range phase. If the child is looking at materials, these materials are important and often the most familiar to the child. “That’s your Elmo. He is red with white round eyes.”
Planned Use of Salient Feature Discussion:
I love to use attribute trays to discuss salient qualities. If the child likes balls, I would create a salient feature tray of balls. This allows discussion of the favorite colored ball and salient language.
- The first kind of tray would contain all the same colored, favorite balls. The number presented would depend on how many items in an array a child can tolerate as determined by assessment using the CVI Range. “That’s your favorite red ball. Its round. It is small and fits into your hand. Its lightweight. Oh, you dropped it, and it rolled”. There is another one. It is red too. You dropped it and it rolled”.
- The next kind of tray would include several favorite balls and one added item that was very dissimilar in shape, size and color. Discussion would include: “That is a spoon. It is silver with a long handle. It is not red. It is not round. It does not roll when you dropped it. It is not a ball.
- The next kind of tray would include multiple kinds of balls of various sizes, weights, textures and colors. Discussion could focus on the similarities and differences of the balls.
The school year will begin with the children arriving on Monday. We have worked hard this summer to get ready for the new school environment to ensure the best environmental and learning supports to meet Kevin’s visual needs as assessed on the Christine Roman-Lantzy CVI Range (2007).
I am so thrilled to be working with a new teacher who already excited to embrace the student with CVI in her classroom. This child has the added learning profile of a child with deafblindness. Even with CVI, vision is his primary way to assess learning.
We are working together with the team to establish a very predictable routine for this child with consistent materials, locations and events that will build visual skills and concept understanding.
Here is just a sample:
- Meet at the van: At curb greet him with our name sign and visual symbol (all symbols are in colors that this child can access) against a black background. Sign “hi” and sign “go”.
- Provide touch cues for travel direction changes.
- Outside the room, show “classroom” symbol in his left field with movement and wait time:
- Textured light up ball on a short string- hand under hand sign school and say “school” (hand comes down on the ball in your hand 2 times)
- Hold it up in his left visual field and give it movement (L side)
- Then bounce it 3 times (yo-yo motion).
- Hold his backpack in his left visual field at eye level, giving slight movement and wait for him to look.
- Put back pack on his lap and pat it.
- Put the large highlighted zipper-pull in his left hand and using hand under hand support, unzip the bag
- Pull out his glasses and hearing aides out of the backpack with hand under hand support.
- Display each in his left visual field at eye level with slight movement until he can look. (all items are presented with a black background to reduce complexity). Present touch cue. Glasses: touch both sides of his face where the glasses stems rest. Hearing aids: touch each ear.
Every day will be predictable. Material will become familiar.
Everyday, Kevin will see the same things in the same way at the same time.
From here, we build visual skills, anticipation and concept learning in his new school!
Riding in a car is something most of us do regularly. We want the child with CVI to have visual opportunities during this time. Here are some strategies to provide this visual access:
- Light is coming through the window on the side of the child. This light and movement often draws a child’s visual attention. Lightgazing is a primitive, early visual skill. To encourage more purposeful vision use, hang a visual target on the window. That visual target is now backlighted by the light coming from the window. Making sure this target moves (slinky, things hung by elastic, or perhaps beads) capitalizes on the child’s possible need for movement and light. Also remember shiny objects simulates movement because they are reflective so these materials would also be useful here.
- Most children are seated on the passenger side where the movement and light draw attention to the child’s right visual field. Shake it up and place the child on the left side of the backseat. Now the movement and light (with added interesting visual target) are coming from the left side to challenge that visual field.
- Create a black background using a black cloth hung on the seat in front of the child. Hang visual targets from this new active visual learning opportunity. The cloth can drape from the seatback to the child’s lap. Attaching a soft hair scrunchie on the child’s wrist will create an opportunity for the child to see movement they control. I have had great success attaching slinkys or beads to this backdrop and to the child’s wrist. How powerful for the child to see movement they created!
Please remember every strategy is developed after assessment using the Christine Roman CVI Range. The goal is to provide visual opportunities matched to visual need. You will only understand that visual need after assessment.
I think of myself sitting in a lecture about mutual funds and financial planning. I could sit there but I do not find this topic of any interest. I will struggle to visually and auditorally attend because I am not excited about this new information. Over time, I will learn this if I gave it great effort but the motivation is so limited.
Place me in a lecture hall about childhood brain development and I am captivated! I will learn it quickly, give the information great attention, use it in my work and remember it long after the lecture is over.
Given that we all learn about things that matter to us, it is of the greatest importance to use materials, activities and games that children like best when teaching concepts in all areas. This is especially true for children with CVI due to the characteristic of Novelty. If we know that children like certain toys, games or materials, we know these are visually, auditorally and tactilely familiar. Children will have the greatest overall abilities and motivation using these favorite things.
Who knows about children’s favorite things? Parents! Here is a “Likes List” that I developed to gather this valuable information from the people who know children best:
I wonder if I could ask you very busy parents to do a bit of work? We all feel that the optimal way to begin our relationship with children is to meet them with their favorite things and activities. Children learn best when they are engaged in activities of interest to them (I think we all do!)
Could I ask you to create a “likes” list for me?
- What are your child’s favorite:
- Cartoon characters
- People and favorite activities with those people
- IPAD apps
- Rough housing games
- TV shows
Thank you. I can’t tell you how much this will help!
Teacher for Students with Visual Impairments
People have asked what is that box on the side of the walker. After this student with deafness and very low vision due to CVI gets into his walker, he travels to the cafeteria to buy yogurt. He places the dollar for yogurt into the black box. The tab to lift the box is highlighted in red shiny duct tape so he knows where to grab to lift and open. He travels the hallways and turns at the large, shiny red triangles that mark each turn. The cafeteria has distinct bank of lights so he understands when he has arrived. He greets and then thanks the cafeteria worker using a red switch. He then can travel back to class.
This color highlighting to the handles of the walker give the child a clear visual target. It highlights the best place to grab to stabilize for transfer into this equipment. This assists the visual motor characteristic in vision for function.