learning considerations for CVI

Visual Attributes: A Strategy for Visual Recognition for Children with CVI

The teaching of verbal visual attributes features begins at birth.  It should be part of a child’s educational programming suggested to parents and teams. We would be careful to limit the auditory distraction of verbal visual attributes features 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 Verbal Visual Attributes Features

Narration of the verbal visual attributes features regarded by the child becomes a philosophy of instruction throughout the day.  This would provide verbal visual attributes features around items that a child can see at near and distance. 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 Verbal Visual Attributes Features:

I love to use attribute trays to discuss visual attributes. If the child likes balls, I would create a visual attribute tray of different balls.  This allows discussion of the colored balls and attribute 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 due to clutter “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.

 

Touch Cues

Touch cues are receptive communication cues that are very important for all children with visual loss. Children with CVI benefit from touch cues for greetings and before touching or moving their bodies. Consistent touch cues allow the child to anticipate what is happening next and who is touching them. Using touch cues reduces anxiety and increases the child’s sense of control over the world.

The touch cues are given directly to the part of the child’s body that will be touched or moved.

  • Touch to the foot before moving it to put on a sock or shoe.
  • Touch to the chin before giving the bottle.
  • Touch to the arm before moving it to place in a sleeve.

Using consistent person identifier touch allows the child to understand who is interacting with them

  • Dad always holds my knee when greeting me.
  • Mom always strokes my upper arm when she greets me.

 

Touch cues can be directional:

  • Pushing slightly in the direction of the roll before rolling them over on their side.
  • Stroking down the sides of the head before pulling the shirt down over the head.
  • Stroking both legs downwards before pulling down the pants.

 

As the child becomes familiar with a touch cue, give the cue and wait slightly. Does the child raise the leg that the cue indicated? This is wonderful expressive communication and tells us much about the child’s understanding of the touch cue and ability to anticipate.

Touch cues can be developed by anyone but must be consistently used by all for optimal understanding.

Vision Impacts All Development for Kids with CVI and Other Visual Issues

Cognition

Understanding of Objects/Relationships between objects: child with visual impairments, including CVI, are aware of fewer possible objects in the environment with which to interact. Those that are touched and experienced are often misunderstood with fragmented and limited conceptual understanding. Interactions between objects and events are inaccessible without tactile and auditory support.

Object Permanence: Objects must be tactilely explored to even know of their existence. Object permanence develops later for children with visual impairments including CVI. Without vision, there are just fewer opportunities to build learn this concept.

Cause and Effect: Objects must be touched to create a reaction and the reaction must be tactile or auditory.

Spatial relations: Visual relationships between items are limited. Comparisons of attributes (size, shape, color, relative size etc.) are limited. Positions between and among objects must be explored tactilely and through auditory channels.

Concept development: The child must directly explore real items in the real situations in the real world to gain more complete understanding. Incidental learning is missed and concepts reinforced more often.

Communication: Children lack complete access to the facial expressions, body language, gestures, and referenced pointing, all of which build language concepts. They might have limited or no eye contact to promote social interactions. Children with limited eye contacted are addressed and communicated with less often and for shorter period of time. Because they are listening, they are often described as “good babies”. Because they are quiet, people leave them alone more often. They might have reduced language tied to concepts due to limited object and interaction experience. (dogs, puppies, Collies, Golden Retrievers are all dogs). Pronouns are confused due to lack of a visual reference. Play is often are self focused play (tactile, movement or auditory play) rather than outwardly focused on materials in the world. Children often imitate parts of language heard echoing language.

Gross Motor Development

Children with visual impairments may seem passive and need intervention to purposefully explore and know what there is to explore. The developmental milestones occur with some fragmented sequences (limited lifting head while on the stomach, delayed sitting, standing, and walking). These all benefit from compensatory skills use to build motor skills. (let children crawl to sounds rather than handing toys to them all the time, placing sound making toys up on surfaces to encourage pulling to stand and cruising). With less movement there is often low muscle tone in the truck and arms.  With less experience and without vision there is delayed or poor protective and balancing skills.

Fine Motor Development

Mouthing remains a primary tactile sensory organ for a longer period of time. This is seen as rolling items on the lips and tongue rather than biting items.

With poor experiences using the arms and hands, there is overall weakness. This impacts Braille learning. Tactile defensiveness may develop as people grab their hands to exploration items. The child had no idea what their hands with encounter and they begin to resist this interaction. This lessens reaching to explore. Parents and teachers should use hand under hand exploration to allow children the option of disengaging. Without direct teaching there are delays in activities of daily living such as hair brushing, tooth care etc.

Social-Emotional Development

Bonding is often impacted due to lack of eye contact. Parents and teachers need to look for non-visual cues to a babies needs and interactions. Children are dependent upon parents and teachers to introduce and provide explorations of the environment. Children often have the “good fairy” syndrome.  Things appear and disappear in their world. Overall independent must be supported.