1 Cortical Visual Impairment (CVI): Implementing Strategies for Increasing Visual Functioning Presented by Deena Recker, M.ED
2 Cortical Visual Impairment (CVI) refers to the inability of the brain to process visual information that is provided by the eye. In CVI, the eye is gathering visual information and sending it to the brain for processing, but somewhere along the pathway the information gets lost or diverted. Like a train rolling along until it hits a mass a tangled tracks. The information is stopped and unable to reach its destination.
3 WHAT CAUSES CVI? CVI is frequently seen in children who were born prematurely, have neurological disorders, or have some form of brain injury. When the brain is compromised before, during or after birth, it is possible for CVI to be present.
4 Now that the problem is understood, there is GOOD NEWS!It is possible for students with CVI to IMPROVE the use of their vision! This makes CVI unique to all other eye conditions. The plasticity of the brain and its ability to recover from significant injury is responsible for this improvement in visual recovery. NEVER PLACE LIMITS on the ability of your student to improve. The brain is a remarkable tool and is constantly surprising us.
5 Have student, have recommendations, now what?Because CVI can improve, students experience CVI differently. There are three phases, Phase I, II and III. The higher the number, the better use of vision your student is demonstrating. No need to worry about the phase in which your student is functioning. A Functional Vision Assessment, completed by the Teacher of the Visually Impaired (TVI), will accompany your student and contain this information. It will also have a list of recommendations. Have student, have recommendations, now what?
6 10 Characteristics of CVIBasic information to help understand how CVI impacts vision: 10 Characteristics of CVI 1. Color: preference for a specific color (favorite color) 2. Movement: need or preference for movement 3. L a t e n c y: delayed response when looking at objects 4. Visual Fields: visual field preferences 5. Complexity: difficulty with visual complexity (keep it simple) 6. Light-gazing and/or non-purposeful gazing 7. Distance viewing: distance vision impaired 8. Visual Reflexive Responses: visual blink reflex is absent or impaired 9. Visual Novelty: preference for familiar objects 10. Visual Motor: impaired visually guided reach
7 Where the rubber meets the road!
8 MOST IMPORTANT: Pay careful attention to the environment.Students with CVI may have difficulty using their vision when: There is a lot of noise, either voices or ambient sounds (music class, walking in the hallway, cafeteria, etc.) Sunshine streams in a window or other light sources are in their line of sight The area within their visual range is busy or cluttered A favored color is within their visual range, pulling their attention from the object being viewed
9 Ensure that you and others assisting the student are not a distraction.When a student is visually attending, do not speak. This includes encouraging the student to see. While waiting for a student to visually attend, do not whisper to other staff/students or tap on a cell phone. This is noise. Making eye contact can be very challenging for the student, so do not assume he/she is not listening if they are not looking at you. Check your clothing and accessories. You may need to cover a bright blouse with a sweater, apron or smock.
10 Since light is a powerful tool to use with a student who is experiencing the effects of CVI, using a Light Box is a good way to get and maintain visual attention. Regular size light box Mini light box
11 This container is translucent, so light passes through itThis container is translucent, so light passes through it. It has 3 compartments which can be used for sorting, learning in/out, left/middle/right, between, etc. Here the container is being used for matching.
12 Work on color and shape identificationObjects do not have to allow the light to travel through them, but the light draws the visual attention of the student. The light box has a control to brighten or dim the light. Notice these items were turned around to reduce the complexity. No faces! Work on color and shape identification Positional concepts: left, right, between Size differences
13 Adding light to objects can make them appear to have movement. Always shine a light from behind a student’s shoulder. Objects that light from within may also provide stimulus.
14 Reducing complexity One item, in preferred color, on a contrasting background makes it much easier to locate and view the object. Same object on a non-contrasting background that is very busy. This makes the object difficult to locate, even with good vision.
15 Let’s look at some examples of modifying lessons.Just being able to visually attend and read for a short time does not help our students with long term learning. Students need to be able to access visual information comfortably so that they are less likely to develop eye strain, which can lead to headaches, as well as make visual tasks unpleasant. Just being able to visually attend and read for a short time does not help our students with long term learning. Students need to be able to access visual information comfortably so that they are less likely to develop eye strain, which can lead to headaches, as well as make visual tasks unpleasant. Let’s look at some examples of modifying lessons.
16 Using the student’s preferred color in reading.Outlining the letter in black or a favorite color can help with gaining and maintaining visual attention.
17 Changing the background color or the size of the object may help.Outlining using the favored color of the student can also draw attention to the object.
18 Using real objects, instead of 2-D pictures can also aid in visual functioning and understanding.
19 This cute Pooh Bear shape card seems simple, but when looking closer what do we see?Especially when introducing new material, keep it simple. Circle
20 Adding and subtracting with real objects.=
21 Example of one page from a student textbook.
22
23
24
25
26
27
28 Side by side, it may be easier to see the reduction in visual clutter and complexity. This will make it easier for students to learn and practice new material.
29
30 Providing a little extra help with new material with a Phase III student in music.
31 Positioning when working with a student
32
33 If possible, find a place away from the regular classroom. If it is recommended for the student to do visual tasks in a quiet environment, be creative to find space. If possible, find a place away from the regular classroom. At the least, move to an area of the classroom away from others. Consider placing a partition up to control the visual environment, as well as assist with reducing sounds. Blankets, floor mats, etc. Set mats on ends and use as a wall. Make a blanket fort using chairs or tables.
34 Using the recommendations made on a Functional Vision AssessmentSECTION 6 – Recommendations for student B Present items with bright colors or sharp contrast. She is able to view items of more than one color. Avoid visual clutter. A black background may be used to help B focus on an item. This will help to reduce the visual complexity of her surroundings. Light may be used to encourage B to look at a target, but avoid extended use of blinking lights. B may prefer familiar items for viewing. She may require multiple presentations of an object before she becomes comfortable exploring it. Allow B time to look at items. Her visual latency may require 5-10 seconds for her to focus and choose to look at the item. She may benefit from having items placed within 6 inches to view. B may prefer to have items presented on her left side, but it is important to vary presentation to encourage a wider range of vision. Safety precautions need to be in place to protect B, as her blink reflex is delayed. B appears unable to see details beyond a 12 inch range, and will bring items to within 3 inches of her eyes for closer examination.
35 Easier to read: SECTION 6 – Recommendations for student B Present items with bright colors or sharp contrast. She is able to view items of more than one color. Avoid visual clutter. A black background may be used to help B focus on an item. This will help to reduce the visual complexity of her surroundings. Light may be used to encourage B to look at a target, but avoid extended use of blinking lights. B may prefer familiar items for viewing. She may require multiple presentations of an object before she becomes comfortable exploring it. Allow B time to look at items. Her visual latency may require 5-10 seconds for her to focus and choose to look at the item. She may benefit from having items placed within 6 inches to view.
36 B may prefer to have items presented on her left side, but it is important to vary presentation to encourage a wider range of vision. Safety precautions need to be in place to protect B, as her blink reflex is delayed. B appears unable to see details beyond a 12 inch range, and will bring items to within 3 inches of her eyes for closer examination.
37 Recommendations for student Z:1. When asking Z to use her vision as a part of her instruction, limit the complexity of the visual component of the task. a. Visual targets should always be presented before a high contrast, low complexity background. b. Visual tasks should be attempted in an environment of diminished lighting that is quiet and does not have others moving about. 2. When presenting a target, first move it until you see Z begin to fix upon the target, then hold it stationary for a period before asking for any action to be taken upon the target.
38 3. When it is desired for Z to examine a target in the distance it will be necessary for the target to be brought to her or bring her to the target. She cannot access smaller visual targets at the same distance as her peers. Try to get smaller targets (1”-2”) within 6” of her face. 4. Z shows a very significant response to visual fatigue. After as little as 5 minutes of work using her eyes, her visual system seems to shut down and a non-purposeful gaze is evident. This is a clue to give her a minute or two to rest her eyes, and herself in general, before continuing an activity.
39 How to contact your Teacher of the Visually Impaired (TVI)RESOURCES The Iowa Educational Services for the Blind and Visually Impaired (IESBVI) does have some resources to assist you. There is a lending library which the TVI can access and order materials for your student. First person to ask about materials is the Teacher of the Visually Impaired who is working with the student. IESBVI offers a 4 week online course on implementing CVI strategies via AEA PD Online. This course is offered yearly and you can receive either 1 graduate or licensure credit. How to contact your Teacher of the Visually Impaired (TVI) Easiest way: use the Directory from your AEA. Use the Braille School website at Path is Contact Us Employee Contact Information Preferred method to contact the Vision Team is in writing, via .
40 There is a small collection of books designed specifically for students with CVI and these are available from IESBVI. Samples: My Happy Birthday Party – simple pictures, mostly 1 to a page; the color used in this book is mainly red. The words are opposite the page with the picture and can be folded back so they are not seen by the student. My Shape and Color Book – there are no words in this book, only different shapes with color combinations. This book may also be used to determine color preference, shape recognition, to determine field preference, positional concepts, assessment of visual tracking on the page and counting.
41 Bill the Duck and the Ladybug – simple story of Bill watching a Ladybug move around the page; can also be used to learn/reinforce positional concepts. Words are on opposite side of the page from the pictures to limit visual clutter. Where is the Ball? – This is a version of “Where’s Waldo?” except it is MUCH simpler. It begins with one picture plus the ball and advances to multiple pictures with the ball. This book may provide ongoing assessment of how many objects a student is able to visually attend to at once. Having the student place a small red ball on the picture of the ball when he/she locates it incorporates vision and touch.
42 Time to practice what we have learned!