Transcript Cortical Visual Impairment CVI

By: Julie Kushman
Dr. Christine Roman-Lantzy 2007
Stephanie Steffer
MDE-LIO State CVI Team
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What is CVI?
10 Characteristics
Accommodations/Hands on Experience
A Cortical Visual Impairment (CVI) is the delay in processing information from
the eyes to the brain. The anatomy of the eyes is typically normal, but there
can be an additional ocular loss. Children with CVI must meet the all of the
following criteria: normal eye exams or an eye exam that reveals an eye
condition that cannot explain the profound lack of functional vision, a
medical history that includes neurological damage, and the presence of
unique visual and behavioral characteristics. The visual and behavioral
characteristics consist of: color preference, latency, visual field preference,
complexity, light-gazing, distance, visual reflex, visual novelty, and a visually
guided reach. Ninety percent of information processed by the brain is done
visually. During infancy, the visual pathway is still developing and therefore
vision can improve with consistent function. Although this critical window of
time occurs during infancy, it is unknown when this period ends; as a result
progress for older students should still be expected but at a slower rate. Dr.
Christine Roman's research has shown an increase of visual function to
Phase III within 3.7 years. Each student needs materials that match their
visual experiences and accommodations to their environments to provide an
appropriate intervention.
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Unlike the majority of ocular disorders, CVI is
a condition in which improvement in vision is
not only possible but likely.
At this time the leading cause of blindness in
young children is CVI (Noted by the American
Printing House for the Blind, keeper of a
national census of young blind and visually
impaired children in the country)
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An ocular condition consists of an
imperfection in the anatomy of the eye.
CVI is the processing from the eyes to the
brain.
A person can have an ocular loss and CVI.
*Eye Exam that doesn’t explain the significant lack of
visual function
*History of neurological disorders associated with CVI
*Unique visual and behavioral characteristics
Eye doctors do not always include this piece in
their evaluation.
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Parents are the true experts when it comes to
how their children use their vision.
It is important to communicate with the
family for the consistency of the intervention.
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1. Questionnaire with the parent: It is
important to collect data on how the student
uses their vision.
2. Questionnaire with the classroom staff:
Again, we are collecting data on how the
student is using their vision.
3. CVI Screening: Trained staff will identify
how they are using their vision and what
accommodations are most useful.
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4. Education on CVI: It is important for
everyone that works with the student to
understand CVI.
5. Implement Intervention: A report is
written and an intervention is created to
share with the team/family.
6. Monitoring: VI teacher checks in with the
team monthly and an annual evaluation is
scheduled. The intervention should be
gauged by the progress of the student.
 Resolved Characteristics: No longer a factor
affecting visual functioning
 Visual Latency: Delayed responses in
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looking at objects
Visual Novelty: Quality of being new
Visual Anchor: Familiar visual target
Visual Array: Arrangement of objects
Salient Features: Noticeable or important
characteristics
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Complexity
Distance Viewing
Visual Fields
Visual Novelty
Latency
Absence of a Visually Guided Reach
Color
Movement
Light Gazing and Non-Purposeful Gaze
Atypical Visual Reflexes
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3 parts
 Surface of object (image is difficult to process)
 Background (Where’s Waldo picture)
 Sensory environment (Auditory distractions)
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Items that are complex:
 Faces
▪ Multiple hair styles, make-up, facial expressions, we typically
talk when close up, wearing perfume
 Reflective silver
▪ Shows the color of the rainbow/ multiple colors
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Distance adds complexity of array.
This may be why a student is not able to
identify an item until they are very close.
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Where does the child see best?
• Most common field is peripheral first
then central. Ex: Deer while driving.
• Typically, a student has a preferred side of vision.
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Lower field loss is very common
APH Federal
Quota Monies
Free to VI
students
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New items are difficult
Parents are a good resource to identify
favorite or familiar objects
Example:
 Which one would be easier to recognize– your
name or random letters? (Julie, LKlJa)
 When you ask your husband to find the rice and
he says he can’t see it. Sorry guys 
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Delayed response. Allow plenty of time for
the student to process the information.
Sometimes it may take up to 2 minutes for
the student to look at the item, processes the
information, and then give a response. Be
patient!
Ex: How long does it take you to
pay bills when your child is
screaming? Hard to focus, huh?
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Look and reach as a separate event.
• Their brain is processing two things: vision and motor
control.
Example: when a student sees a raisin, they move
their arm towards the item, then turn their head
away, and finally tactually search for the raisin
on the table.
Example: when a student was shooting a
basketball, she would look at the hoop, and then
turn her head as she was shooting.
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Look, look away, and look back behavior:
 student may look at an object for a few seconds and
look away. If you pay attention, the student may
look back at the item. Make sure you are providing
enough time for the student to look back at the item
before you move it. (1-2 minutes to observe) This is
the student telling us that it is difficult to look at the
object, but they are really interested in it.
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Typically red or yellow are easiest.
 If we are unsure then red is the go to color.)
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Objects of a single color are easier than
objects with multiple colors.
Use the preferred color as a visual “anchor”
 The object you want the child to look at should be
in their preferred color or outlined in that color.
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Example:
 Yellow: highlighters, yield sign, and a school bus
 Red: stop signs, emergency lights, brake lights.
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Movement attracts attention to an item.
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Reflective properties: mylar or glitter
Shake/move the object: slinky
Move light on still object:
Students may shake their heads /yoga ball/rock (DO NOT
TELL THEM TO STOP!!)
Examples:
 Rail Road crossing lights
 Police lights
 Reflective tape on a stair tread.
 Break lights on a car
 When in a crowed area you waive your arms over your
head to get their attention.
 Spotlight when in a dark theater
Light gazing is when a student stares at a window or
lights.
 Non-purposeful gaze may be towards a spinning fan
or staring at the TV when a movie is finished playing
(White noise)
 These are very easy things for the student to look
at. Our goal is for the student to look at and process
more complex items.
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Blink reflex
Cannot be taught, just for testing purposes.
Resolves with other characteristics
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Think of the intervention as opportunities
for consistent viewing. (1-2 minutes
minimum)
The intervention must be incorporated into
the existing daily routine.
Communication with home will be
important.
Pair vision with reward.
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Phase I: Building visual behaviors
Phase II: Integrating vision with function
Phase III: Resolution of remaining
characteristics
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Single color objects
Preferred color
Objects need movement
Simple items and background
Familiar items
Significant latency (wait time)
Lack of a visually guided reach
May localize on objects
Goal: Increase visual attention and build stable and
sustained looking. (Roman)
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Familiar items to the student
Tri-fold board or black material to reduce
complexity.
Preferred color
Reflective tape around objects in daily
routine
Controlled Environment:
 Turn off lights
 Simple background
 Minimize auditory distractions
 Items should be positioned 18 inches or
closer.
 Avoid positioning the student towards lights
when asking to use their vision.
 Present items to their preferred side
Student will begin to demonstrate hand-eyecoordination.
 Purposeful fixation
 Light gazing and non-purposeful gazes should
decrease
 Introduce new items with characteristics of familiar
item
 Blink response to touch is present, but inconsistent
with blink to threat
 May regard familiar faces
Goal: integrate vision with function. Students tend to
demonstrate more consistent eye-to-object contact
with accommodations.
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Introduce two-dimensional images towards
the end of this phase
Tri-fold board or black material to reduce
complexity when needed
Preferred color plus 1-2 colors
Reflective tape around objects in daily
routine
Selection of materials are less restricted
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Visual attention extends up to 6-10 feet
Background noise is tolerated when using
vision
Use vision in performing most tasks and
demonstrate visual curiosity
 Improvement in viewing two-dimensional
images
 View items up to 10-15 feet
 Visually guided reach with small items
 Important to teach sorting skills and salient
features.
 May regard faces
 Uses vision to imitate actions
Goal: resolve CVI characteristics.
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Remove clutter from two-dimensional images. (cut out picture
and put on a simple background. Slowly increase complexity)
Use occluders or window cards
Highlight salient features
Tri-fold board or black material to reduce complexity when in
new environments
Bookshare Website: https://www.bookshare.org/cms/getstarted/sign
Bookshare App:
https://itunes.apple.com/us/app/read2go/id425585903?mt=8
($19.00)
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Practice salient features in unfamiliar
environments.
Visual attention extends beyond 15-20 feet.
Give the
student a
sample of what
they are
looking at
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Hiccupping
Yawning
Gaze avoidance, light-gazing
Keeping eyes closed or frequent periods of
sleeping.
Facial grimacing
Hand or finger tension
Reflexive laughing/high pitched vocalization
Parents
 Studies have shown parents of children with CVI
indicate high level of accuracy regarding child’s
background, history, and performance.
 Implements intervention as recommended
Classroom teacher
 Team leader and coordinator of the IEP team.
 Implements intervention as recommended
Teacher for the Visually Impaired (TVI)
 Screening, report findings, intervention, education on
CVI, and on a monthly and annually basis reevaluates.
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Hand out Eye conditions/Medical conditions
associated with CVI (See Handout)
Sometimes the child see’s it, and sometimes
they don’t.
We don’t know what they can and cannot
see.
They appeared to be totally blind when they
were younger, but now they are doing better.
The eye doctor said there was nothing wrong
with his eyes.
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Put Your CVI Hat On!!!
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Students with CVI benefit from a visual
warm-up just like an athlete does before
working out. When presented with a simple
visual activity, the student can be more
engaged during their lesson.
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Complexity: background
Distance
Accommodations:
 Use a black blanket or tri-fold board
 Position the student closer to the lion
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Color:
Complexity: background or sensory
Accommodations:
 choose student’s preferred color
 Put the items on a black background. Some
students are tactile defensive and may be
distracted by the noodles.
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Complexity: Object and possibly sensory
Color
Accommodations:
 Use a black blanket or tape to cover unused
areas.
 Paint all the keys one color.
 Make sure volume is reduced or off.
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Complexity: Object- poka dots
Color:
Accommodations:
 Use a black blanket or tape to cover unused
areas.
 Paint characters one color or purchase items
that have a simple pattern.
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Complex: Object: pattern
Accommodations:
 Use a black piece of paper to cover the
pattern or purchase a shape sorter that does
not have a pattern.
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Complexity: background
Light-gazing:
Accommodations:
 Close the blinds or position the student with
their back to the window.
Pay attention to your Calendar.
•Color
•Complexity
Pay attention to
what you are
wearing.
Pay attention to
what is in the
background.
This is an idea to utilize
the student’s preferred
color.
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Complexity: background and item
Accommodations:
 Student’s may need real objects. It is easier
to look at the real object rather than a
picture. You could use a piece of the item,
such as a piece of a seat belt to indicate
transition to the bus.
 Present the items in a row or one at a time to
minimize clutter.
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Complexity: Array and Sensory
Color:
Accommodations:
 Minimize the amount of items presented.
 Cover walls with black paper so you can’t see
through the fiberglass.
This is really a Phase II accommodation, but with daily repetition and turning
the lights off and using a flashlight it may be considered as a Phase I
accommodation.
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Reduce the amount of cards that are
presented to the student
Highlight salient features in red.
Teach each picture as a lesson.
 Ex: Duck:
▪ Two webbed feet
▪ Bill for a nose
▪ Feathers
▪ Two wings
▪ Generalize other ducks
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Minimize volume on toys, work in a quiet
room, reduce background noise, or have the
child wear headphones.
Use tri-fold boards, all-in-one boards, or
black felt board.
Prompting: Do not prompt unless you think
the student does not understand the
directions. Silence is golden!!!!
Single color: paint over complex patterns or
be aware of this when making a purchase.
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Eraser app to reduce clutter in pictures:
 Background Eraser for iPhone By handyCloset Inc: ($0.99)
 https://itunes.apple.com/us/app/background-eraser-for-
iphone/id437015777?mt=8
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LST Monitor App (My app, release date in fall)
 http://www.lifesciencetechnologies.com/Vision
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Free app on Friday:
 http://www.smartappsforkids.com
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Bookshare Website:
 https://www.bookshare.org/cms/get-started/sign
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Bookshare App:
https://itunes.apple.com/us/app/read2go/id425585903
?mt=8 ($19.00)
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APH.org (Ask your visually impaired teacher)
 Reading Stand
 Trifold board
 Tactile communication system
 Variable Beam Flashlight Kit
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Triple home click
Guided access
Use the lock screen/ toggle bar
Inverted colors: FUN/Photphobia/peripheral loss
Voice Over/Speak
Zoom: pinch/expand and three finger double tap.