Transcript Minimally Responsive Child - American Printing House for

CORTICAL VISUAL
IMPAIRMENT
Children with CVI are those
in whom visual dysfunction
is caused by lesions in the
posterior visual pathways
and or occipital lobes and
results in temporary or
permanent loss of vision.
COMMON ETIOLOGIES
 Prenatal

Toxemia, intrauterine infection
 Perinatal

Asphyxia, meningitis, encephalitis
 Acquired

Tumor, trauma, cardiac arrest, seizures,
shunt malfunction
DIAGNOSTIC CRITERIA
Pupillary
reaction is normal
Optic refractive media and
fundus appear normal
Blink to threat is absent
Tracking behaviors usually
absent
CHARACTERISTIC BEHAVIORS
Eye
contact and visual
communication skills are poor
Often appear uninterested in
surroundings
May turn away from people and
events in their environment
Photophobia often coexists with
light gazing
VISUAL FUNCTIONING
Fluctuations in visual
functioning
 Familiar objects
recognized in one
environment and not
others
 Visual attention is
highly variable
 Visually locates object
then looks away before
reaching for object

Distance vision is
apparent, but children
may bring objects in
close to block out
visual clutter and
chaos
 Verbal and tactile
cuing is helpful for
some children, but may
provide too much
distraction for others

FLUCTUATIONS IN VISUAL
FUNCTIONING
 Visual
functioning is influenced by:
 Tiredness
 Unfamiliar environments
 Illness
 Complex visual information
 Poor lighting
 Medications
 Seizures
VISUAL PERCEPTION
Color
vision is a strength for
children with CVI
Colors are more easily
recognizable than shapes
Yellow and red seem to be the
preferred colors
VISUAL PERCEPTION
(CON’T)
May only be able to attend to one object at a time
 Need sufficient distance between objects to
distinguish them
 Attend better to objects in motion
 Discrimination of foreground from background is
difficult

RESOLUTION OF CVI
 25
to 50 percent of children with CVI
recover some useful vision
 First three years of life are optimal
time for resolution of CVI
 First two to three years after
accident/trauma to the brain are
optimal for recovery of vision
However, resolution can occur into
the teens and beyond!
ASSESSMENT AND INTERVENTION
STRATEGIES
 Use
vestibular input to alert visual
system
 Insure proper seating, support and
alignment
 Avoid overwhelming the visual system
with complex visual stimuli
 Allow time for observation, assimilation
and response
ADDITIONAL ASSESSMENT AND
INTERVENTION STRATEGIES
Illuminated toys
 Toys with motion, or
those that appear to
have motion
 Single stimulus
 Colored objects and
toys
 Highlight aspects of
toys, objects, shapes,
etc. with favorite colors

Wide separation
between array of
objects
 Books with single
picture on each page
 High contrast between
foreground and
background
 Familiar toys and
objects

ISAVE CVI PROTOCOL


Complete the Developmental History and Ocular
Examination sections of the CVI protocol after
interviewing caregivers and reviewing referral
information, developmental history, and medical
records.
Transfer observations from other ISAVE
components to the CVI protocol, especially those
from the Ecological Observations component.
CVI PROTOCOL: DEVELOPMENTAL
HISTORY
 Complete
thorough interviews with
caregivers and review of medical
information
 Check all markers on the protocol
that are relevant for the child.
CVI PROTOCOL: OCULAR EXAMINATION
 Gather
information using reports
from ophthalmologist or other eye
care professional.
 Check all markers on the protocol
that are relevant for the child.
CVI PROTOCOL: ADDITIONAL AREAS
o Appearance
o Visual Functioning,
o Visual Perceptual Characteristics
o Sensory Modalities
o Posture and
o Movement Characteristics
CVI PROTOCOL: IMPRESSIONS AND
RECOMMENDATIONS
Indicate your impressions and
recommendations for further
services and additional referrals.
SUMMARY
 Transfer
results from the CVI
component to the ISAVE Summary
Protocol.