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Perkins CVI for the TVI Webinar, December 2020 presented by Jennifer Siff

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Supporting CVI during Orientation & Mobility

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CVI for the TVI webinar series: December 2020

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Team: Literacy and Complex Communication Needs

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Team: Literacy and Complex Communication Needs

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How the Classroom Teacher, Speech Language Pathologist, and Teacher of Students with Visual Impairment came together to support one another and increase student engagement with a Reading Group

"It just seems like her days could be so much more productive."

"She spends a lot of instruction time with her head down."

"I can barely get her to stay awake."

"I just feel like we could do better for her......."

These were the weekly conversations shared by a highly structured moderate-severe special needs classroom teacher, Teacher of Students with Visual Impairments, and Speech Language Pathologist as we lamented the lack of engagement of a specific student. We were all frustrated with the effectiveness of her instruction, and wanted more for her, but struggled to pinpoint a quick and easy solution to our dilemma.

Collaborating through a Group Activity with Targeted Instruction

We brainstormed how we could work together more collaboratively to increase our students' engagement. We decided to use a group activity as a vehicle for us to support each other's goals through targeted instruction. We realized creating a daily Reading Group with these students (and their peers who have a variety of other areas of need) using real objects paired with a simple text would be a great place to start. This process allowed each of us to focus on the individual skills we wanted to address with the students in terms of vision, speech, and literacy, while working in a collaborative format.

Need for Meaningful Direct Experience

When brainstorming together, it became clear that the biggest obstacle our students were facing was a lack of schema compared to typically developing peers. They had no way to anchor the vocabulary in most texts presented to them, without meaningful experiences with which to connect the words. This led us to realize the opportunity (and responsibility) we have in providing and creating meaningful, direct experiences with objects within the text for these students. In the beginning, we decided to narrow our focus to 3 objects per text in an effort to identify the most important ideas while not overwhelming our students (and ourselves).

We are now able to expand to more objects and easily differentiate for individual students with this format. Some of our students use color print outs of the text, some view it as an ebook on their tablet, some use objects only presented with CVI supports, and some use copies with salient features highlighted. We use a black mat and light to support the needs of some of our students. Using these strategies and techniques provides a reading group that has led to much greater student engagement in addition to improvement in the academic, communication and functional vision skills each of us were looking for individually. Additionally, we have FUN sharing and learning together.

Selecting Objects

Objects are chosen based on their ability to represent a salient feature of the target vocabulary word. For example, a teddy bear is represented by an actual stuffed teddy with soft fur, to allow students to feel the soft fur and understand that means teddy bear. The target word "candy" is reinforced with a taste of candy in order to provide a gustatory connection for the student. A bat was represented with Halloween dress up teeth for the student to feel to understand that that the bat had sharp teeth. Items can be touched, smelled, tasted, heard or experienced in multiple ways in order to build the most rich understanding possible of a concept for our students.

Choosing Texts

The texts that are chosen typically coincide with holidays or seasons, current happenings in the school or community, concept development skills (big, little, up, down, colors, etc.) and activities of daily living. We try to use timely and relevant text in order to help the students build connections with vocabulary they are hearing in the regular education setting, community, and home. For example, in early to mid February, they will hear a lot about Valentine's Day, flowers, and candy. One text in the spring time was about a baseball game. Helping them understand these concepts fosters their ability to connect to family and friends even outside the group.

Reading A-Z

We have found Reading A-Z to be a wonderful resource for finding age appropriate texts that are simple, bold, and often have real photographs of real objects and people for "illustrations", as we know interpreting drawn illustrations can often be difficult for children with CVI. We also use commercially available texts and adapt as needed for specific students, while still pairing with real objects to amplify connections and have found a multitude of ideas through the Paths to Literacy website.

The reading group meets daily for 30 minutes and follows a specific order of events that includes student jobs, goal setting for improved behaviors, a weekly poem, the shared reading of the text, visual and tactile exploration of the paired objects, and a time for self-reflection on the goals they set at the beginning. After the conclusion of the self-reflection, the students transition to a movement break activity, and then some individual work time.

Sample Reading Group Books and Activities

Below are some pictures of texts and objects we have used during our Reading Group.

This book is called " Mash The Potatoes". On Friday of each week there is an extension activity to each text. During the week, the objects (potato, potato masher and fork) were used to facilitate a connection to the text. On Friday we made (and tasted if able to) mashed potatoes, further reinforcing the concept.

Below is a sample of some of the titles we have used in the past. As you can see, the texts are functional and easy to pair with real objects to create direct and meaningful experiences and extension activities to connect students with the text and deepen literacy skills:

Lunch at School

My School Bus

How to Make a Salad

We Go Camping

1-1 Correspondence: One, Two....Twelve

Colors: Blue, Orange...

Positional Concepts (On, off, under...)

The Backyard

The Playground

The Birthday Party

Valentine's Day Gifts

My Classroom

My Bath

My Closet

It is Fall, Spring

....and the list goes on and on.

Increased Student Engagement

By monitoring students' response to the text by documenting signs of engagement, we were able to see an increase in average time of engagement of 64% when using objects. Anecdotally, we also noticed that after repeated exposures to the text, they began to anticipate the coming tactile experience as evidenced by lip smacking at the word "candy" before the object was presented, or crying and retracting hands at the word "rain" before the water was sprayed on the hands. Clearly, the students had learned what to expect in connection to these words, thus, they had learned the words! Moreover, the same terminology "Are you ready to read?" was used at the start of each group. After repeated exposures, the students began to vocalize and respond to this introductory phrase, demonstrating that they knew what was coming in reading group. They understood that they were readers!

Start a Reading Group of Your Own!

This group has been a game changer for the instructional practice for all three professionals involved. Our students at all levels are engaged and growing in their literacy skills. They are interacting with the books and with each other in powerful ways. The group has provided a natural environment in which to target social skills and self advocacy, passing objects, asking for turns, etc. The peers in the group who are able to read have grown leaps and bounds in their comprehension and decoding skills, as they build layers of understanding to their schema and concepts of vocabulary. The adults are motivated to support the students, and the time is interactive and fun for all. Multiple goals are easily targeted and documented. It is a win all the way around. Collaboration has brought this beautiful group from an idea to the most powerful 30 minutes of our instructional day. So, gather your team together and start a reading group of your own!

Reading A-Z https://www.readinga-z.com/

Erin Marvin, M.S., CCC-SLP

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Team Approach to Literacy for Students with Cortical Visual Impairment and Complex Communication Needs

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"It just seems like her days could be so much more productive." "She spends a lot of instruction time with her head down." "I can barely get her to stay awake." "I just feel like we could do better for her......."

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Collaboration among team members is important for

determining and implementing visual access for the child with CVI.

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Orientation and Mobility resources and strategies for students with Cortical Visual Impairment (CVI)

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O&M Observation Protocol for Students with CVI

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O&M Observation Protocol for Students with CVI

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CVI and Orientation and Mobility resources for IEP teams.

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Part 1: Partial-Object Symbols are MORE than Just a Schedule: Communication Systems for Students with CVI and Multiple Disabilities

The majority of Augmentative and Alternative Communication (AAC) systems available today use visually-based symbols. Often, however, students with multiple disabilities including visual impairments (MDVI) struggle with seeing and interpreting these two-dimensional, flat visual images. This is often due to MDVI students having Cortical Visual Impairment (CVI). For years, I wondered why it was that SOME children with CVI are able to understand these line-drawing based, flat symbols and others are not - until I read Dr. Roman-Lantzy's book, " Cortical Visual Impairment: An Approach to Assessment and Intervention". Dr. Roman-Lanzty states on page 134 that: "By the end of Phase II (CVI Range score of 7) the student will be able to use simple two-dimensional images". My mental "light bulb" was suddenly flipped to ON - no wonder using these line drawings wasn't working for many of my MDVI students with lower CVI Range scores! This highlights something we know but often don't grasp the implications of: seeing something and interpreting & understanding an image are not the same thing. Frequently, a student who has MDVI might see objects and even try to look at pictures and line drawings, but this doesn't mean that they UNDERSTAND what the flat image represents. Once I realized this, my next question was how DO I give these students access to a symbolic communication system despite the severity of their CVI? How do we support their communication needs despite their visual impairment?

3-Dimensional Symbols

Working closely with other team members, we developed a 3-dimensional / partial object based system of symbols to support communication. It met the learning media criteria needed for my student who was a visual learner that struggled with auditory processing and had limited tactile skills. It met the language criteria needed for the student in that it allowed for the organization of language into different categories as is commonly used in many Communication/AAC systems. Categories used often include groups of words such as: questions, telling opinions, people, activities, places, what's wrong, etc. Most importantly, this system used 3-dimensional symbols that were understandable to the student with CVI to represent language. We used the Tactile Connections Kit to create our symbols and the Symbols and Meaning Kit to support implementation of the system, both of which are available through APH.

Designing a Successful Symbol System

The key to this system being successful is that we designed it to support communication and language needs, not just the student's daily activities. It is very easy to make 3-D symbols for a daily schedule: a spoon represents lunch, a book is for reading, counting blocks for math, and so on. What was challenging however was designing symbols for words that are NOT object-based nouns, like happy, go, stop, mad, me, you, more, done.

We started by thinking about the language that the student needed to be able to say. We included words that we wanted her to say, words her peers would use, and most importantly words that the student herself wanted to say.

Next, we figured out how those words would be organized into different categories. The Tactile Connections Kit has 7 different colored & shaped cards, so we identified 7 groups of words that our student needed to access in order to be a successful communicator. We came up with: people (pronouns and proper nouns), things (objects), move (verbs), about (descriptors), places, time (calendar words and ordinal language), and talk (chat language and other common words).

Then we designed the 3-dimensional symbols for each word needed, taking care to select partial-objects or 3-D images that would be meaningful to the student as well as easy to visually identify related to the student's severe CVI needs. Occasionally we had to change a symbol because it was confusing or looked too much like another symbol.

Slowly over time we taught this student the meaning of these symbols through active learning and play-based activities. We focused on the interaction between the student and her partner rather than on the symbols themselves, and immersed her in a language rich environment with lots of opportunities to see use of her symbols modeled by others.

Videos: Using Tactile Symbols in Play-Based Activities and Creating a Book with Tactile Symbols

Student Response to Symbols

The amazing thing is that this student learned the meaning of and understood these symbols! With instruction and practice, she was able to read them, use them to support her communication, and use them for writing. She was the most excited about the words/symbols related to feelings (from the "About" category) and words from the "People" category. Interestingly she had limited interest in using any of the words related to her schedule. If we would have only used 3-D symbols that were schedule-related, the system would not have been successful. During the process of learning how these symbols represent language, her speech became more intelligible as well, primarily because we used the same exact words over and over within her communication system. After a few years of trying so many different things that failed, we finally had a system that worked for this student. Ahhh, the sweet pictures of success!

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Augmentative and Alternative Communication (AAC) Systems for Students with CVI & Multiple Disabilities

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The majority of Augmentative and Alternative Communication (AAC) systems available today use visually-based symbols. Often, however, students with multiple disabilities including visual impairments (MDVI) struggle with seeing and interpreting these two-dimensional, flat visual images. This is often due to MDVI students having Cortical Visual Impairment (CVI).

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Vision Language Learning Communication: An Approach to AAC for Students with CVI

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During this 1 hour webinar, Dr's Blackstone and Roman-Lantzy will discuss AAC for students with CVI

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Augmentative and Alternative Communication (ACC)

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Augmentative and Alternative Communication (ACC)

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Resources for parents, TSVIs, Teachers, SLPs, OTs and other professionals...

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Cortical/cerebral visual impairment (CVI) is the leading cause of visual impairment in children in the US. Start Seeing CVI was created in 2014 to increase awareness and understanding of cortical visual impairment.

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Cortical/cerebral visual impairment (CVI) is the leading cause of visual impairment in children in the US. Start Seeing CVI was created in 2014 to increase awareness and understanding of cortical visual impairment.

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Helping children with cortical visual impairment (CVI) learn to see

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This section contains resources for connecting with other parents and websites designed specifically for parents.

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Salient is an adjective defined as: most noticeable, important, main, principal, chief, or primary. When choosing words to describe the salient characteristics of an object to a child, we should also think "consistent." Choose the characteristics of objects that are never-changing. Think about how you would describe a duck to a child.

After looking at these images of ducks, has your choice of descriptors changed? Now, think about non-visual attributes of the duck that are linked to our understanding of what a duck is. It says quack, it likes to be in the water, it can walk on webbed feet, but we don't see the webbed feet when it is in the water...confusing! Just keep it simple, being as consistent as you can be. A duck has a bill, feathers, wings....Let the child touch, hold and see as many examples of ducks that you can. Make a simple book about ducks, reinforcing those consistent features. Present the ducks next to different ducks and then next to different animals. See if the child can tell the difference and pick out the duck consistently. Several iPad apps are listed at the bottom of this page that may help support children learning about salient characteristics. When deciding which ones to use with a certain child, take into consideration what environmental accommodations the child needs to be successful. Can the child tolerate sound when using vision? Is the background simple or complex? How many items can be displayed at a time? Is there adequate spacing between the items? Use the information you learn through interview, observation, and assessment to help guide your choice of materials for instruction and play.
Building children's vocabulary
Reading Rockets website has an extensive collection of resources about reading, including topical research briefs and reports, descriptions of nonprofit, state and federal literacy organizations, and free reading guides for parents and educators. Their technique for building vocabulary can easily be applied to objects a child encounters throughout his daily routine. http://www.readingrockets.org/article/building-your-childs-vocabulary

iPad Apps for teaching the consistant characteristics of objects through play:

Animal Fun by Brian Pfeil

Large image library of animals presented on a solid, white background, one simple photo at a time. Animal's name is also on the screen in a simple, black font. App will speak the animal's name, spell the name with each letter changing to red as it is spoken, and you can hear the sound the animal makes.

See, Touch, Learn by Brain Parade

Starter image library of simple photographs, individually presented on white background squares (option to purchase more categories). Starts with one photo providing teacher the opportunity to describe the object's characteristics, click on it, hear a ding for correct, then move to a screen with that same photo and one different photo, find it, click on it, move to screen with 3 photos, etc.

Find the Same by Ebenezer School

Library of drawn pictures of shapes, animals, foods, for matching "same." Ability to choose white or black background for pictures, large array of choices (9).

Toddler Tap! by James Miller

Choose from multiple categories including letters, numbers, shapes, food, animals, etc. Screen has simple background with simple images. Large array of images at one time, which is not adjustable, but the pictures are clear drawings. Easy change from English to Spanish auditory.

Animal Pairs Game by Acento Comunicacion

You are given the choice of: easy (6 pictures), medium (12) or difficult (21). Background is complex with a farm scene behind the squares of animal pictures, which you tap to reveal a color drawing of a single animal, you tap a second...if they match you hear the sound that the animal makes, if they don't match, the cards turn back around and you make a another set of choices.

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Salient is an adjective defined as: most noticeable, important, main, principal, chief, or primary. When choosing words to describe the salient characteristics of an object to a child, we should also think "consistent." Choose the characteristics of objects that are never-changing. Think about how you would describe a duck to a child.

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When students with CVI move into Phase 2 they begin to recognize images in 2-dimensional. To help these students continue to progress from Phase 2 to Phase 3 you will need to provide specific strategies to aid in their recognition and interpretation of the 2-D images.

The complexity of pictures in books or throughout their environment and world is often too much for students with CVI to interpret and they are unable to focus on specific details represented.

Simplifying the pictures by pulling out specific details and presenting them on a solid color background can aid in their identification of the most important details.

This is now made easier with apps like You Doodle. The no add version is only $2.99.

There are several ways to use this app.

Option 1

The first is by locating a picture online that you would like to use. Perhaps the student is going to watch the movie "Finding Dory" or will be reading a book about these characters. Perhaps their favorite stuffed animal is a Dory doll and you would like to help them make the connection between the 3-Dimensional stuffed animal and the 2-Dimensional image of Dory.

You can follow these steps outlined below (screenshots included):

Locate image or character needed online by searching on Google and choosing "images".

Choose an image that shows as much of the character as possible.

You can either save the image or just take a screen shot of the image by hitting the home button and power button at the same time.

Open the You Doodle app and choose File in top right corner - Import - Edit a Photo - Camera Roll - Then choose picture from camera roll that pops up - Hit Done in top right corner.

You may want to enlarge the image to work with it by doing a "pinch to zoom" - when zoomed in, you will need to move around using two fingers.

Click on the "Scissors" option in the toolbar at the bottom.

You may also want to use a stylus for this for more control - carefully trace around the image or character - as you do so a circle will pop up magnified as you trace around the image.

Make sure your trace line connects fully.

Once finished tracing - tap anywhere outside the image - a menu will pop up - choose "Trim".

Now, you will add the solid background - choose "Fill" from the toolbar at the bottom.

Tapping "Fill" a second time will pull up the menu where you can choose the background color - I recommend using black as default.

Tap the background around the image and it will fill with the desired color.

Choose File again and save.

You can present the image to the student either on the Ipad, especially if light is still a factor in gaining their visual attention or by printing as a photo.

Option 2

Another option if unable to locate the image online is by taking a picture of the desired image.

I like to use this book, Tracy's Mess (a gift from my mother) as an example of how difficult complexity can be. This is a book where even the isolated images are difficult. But, you may want to look at the book and select specific items that you believe will be easiest for the student.

In this case I chose the "blue truck".

Take a picture with your phone or ipad of the page.

Then follow the same steps from Option 1 to import the image and cut around the image.

Visual Anchor

CVI students often benefit, especially in Phase 2, from what is called a visual anchor. This provides the student with an outline in one of their preferred colors to aid in the attention to the image.

You can also use You Doodle to "outline" the pictures, letters and words with the "glow" option.

Choose the brush or pen option and tap a second time to pull up the menu.

For pictures, choose the same FILL color and GLOW color. The GLOW option will literally have a vibrant glowing effect. You can play around with it to see how much you want to use.

Maximum Glow

Less Glow

For letters and words, choose black as your FILL color and another color as your GLOW color.

There are so many ways you can get creative using the You Doodle App.

I hope this information helps you make accessible materials for your CVI students!

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Using the You Doodle App to Create CVI Accessible Images

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When students with CVI move into Phase 2 they begin to recognize images in 2-dimensional. To help these students continue to progress from Phase 2 to Phase 3 you will need to provide specific strategies to aid in their recognition and interpretation of the 2-D images.

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Android and iOS devices can be very useful tools for students with cortical visual impairment (CVI).

These lists include several favorites...

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Look: A Free Interactive Reading Tool by CVI Scotland

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Look: A Free Interactive Reading Tool by CVI Scotland

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Look is a free reading tool for people with CVI.

A short introduction explaining what Look is and the purpose is available here.

Full instructions explaining the multiple settings are available here.

A section explaining the approach of learning to read using recognition, which has been shown to be helpful for some with CVI is available here.

A case study following eleven year old Katherine's remarkable progress over two months whilst piloting Look for us during development, is available here.

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Look is a free reading tool for people with CVI. A short introduction explaining what Look is and the purpose is available here. Full instructions explaining the multiple settings are available here. A section explaining the approach of learning to read using recognition, which has been shown to be helpful for some with CVI is available here.

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This is the first of two parts on the topic exploring Strategies for Improving Literacy Skills in Students with CVI, presented by Diane Sheline. Watch the webinar or take the tutorial for continuing education credits.

Many teachers that work with students with CVI, or Cortical Visual Impairment, are familiar with Dr. Christine Roman-Lantzy's CVI range. Teachers and parents can begin working with students to develop pre-reading skills even when students are still in CVI Phase II (developing visual attention). These pre-reading skills generally include the following:

Print motivation is one of the most important pre-reading skills to consider - students need to be excited and happy about reading! Make sure book reading time is fun, and be sure to use CVI friendly strategies. Keep reading time short, but do it often during the day, and integrate reading time into routines. You will need to create your own books, using images that are preferred, and that are recognizable and predictable. For each child, these will be different images. There are not a lot of commercially prepared books that are suitable, so be prepared to buy books and cut out the images to mount on black backgrounds. You can also use Tablet Technology to create custom books of high interest to the child. Use books that are predictable, and repeat a non-novel, recognizable item on each page (such as Elmo in the example below).

Choose an object that is motivating to the student (Elmo here is the example), and photograph it on a black background. Use several photos to create a short book of just a few pages.

Buy two or three copies of a favorite book. Cut out the preferred images and mount on a black page.

Start with one image on a page, and then move to books that have two or three images on the page. See if your student can pick out the preferred object (Elmo, for example).

Choose commercial books that are low in complexity, use a favored color, have reflective qualities, and have hard, easy-to-turn pages.

Use spot-lighting techniques to draw attention to images, especially when the illustrations have reflective qualities. Use a strong flashlight, or a task lamp such as an Ott-Lite.

Use an easy-opening spiral binding system such as ProClick, and use the black binder covers as pages in a book. Mount photos or illustrations on the dull side of the paper to avoid glare. Pages can be added and removed as needed.

Use black backgrounds or sheets.

Use Tablet Technology and apps to create custom books featuring favored targets. Use apps such as Pictello and Book Creator. If you are not sure about favored targets, ask the parents what the child likes to look at.

Some apps allow you to record your own story, so that there is an auditory element.

Wear a black cape or smock while working with the student, to minimize distractions from clothing.

Often students respond better in a darkened, no-glare environment, with minimal distraction from noise or sound.

Encourage recognition of 2D photos by using them in conjunction with 3D favored, non-novel targets.

Start with one or two choices. Encourage the student to recognize that the image in the photo (picture of banana) represents the real object, a banana.

Students need to understand that print on a page represents words that are spoken.

Students need to know how to follow words on a page, and how to hold a book.

Point out a recurring letter, such as the "E" in Elmo:

Phonological awareness is the understanding that words are made up of smaller sounds. Phonological awareness general comes before phonics.

Talk about word families that have similar features or patterns, such as "cat, hat, sat"

Students will need experience in matching shapes, letters, and numbers. They will need to understand "same" and "different".

Students will need to know that each letter is different from the others.

Students will need to be able to recognize and name all letters and know that each has a different sound.

You can try letter-sorting games - be sure to use good contrast and remove visual clutter.

Use an All-In-One Board from APH and real objects with Velcro to create scenes or stories.

Ask open-ended questions - "What do you think will happen next?"

It will be important for students to know the names of things, feelings, concepts, and ideas

Label common objects with words.

Point out words that the student comes in contact with during naturally occurring routines.

Next, see Part 2 - Strategies for Beginning Readers

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This is the first of two parts on the topic exploring Strategies for Improving Literacy Skills in Students with CVI, presented by Diane Sheline. Watch the webinar or take the tutorial for continuing education credits. Many teachers that work with students with CVI, or Cortical Visual Impairment, are familiar with Dr. Christine Roman-Lantzy's CVI range.

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When helping my grandson, River, who is almost nine, I know it is critical to use his CVI Range score (Roman-Lantzy), late Phase II, and information about his CVI characteristics as my guide to modifying his literacy materials. I always remind myself that what I can see and understand is different from what River "sees" and understands.

When River and I are together, I do my best to follow his lead so I can gain valuable insight into what he is attending to visually. I try to take advantage of what Dr. Reuven Feuerstein labeled "the concept of mediated learning." This is when the "learning partner" (parent, teacher) intervenes in the child's experience with the intent of teaching something. Dr. Roman-Lantzy refers to this as "joint attention." A label I learned in my teaching days is "kidwatching," and it is powerful. When River gives me verbal feedback about what he sees, and shares his understanding of symbols and images, then as a learning partner, I can hopefully make appropriate adjustments to materials and activities.

There are so many variables in any one literacy activity and I am not the main one doing the instruction. The materials I make for River are mostly for the classroom, but I am not there to observe and assess if they are meeting his needs and providing the right amount of support. Even with the best of ongoing home-school communication, there are no doubt snags along the way.

Below are a combination of iPad Google Slides, samples of modifications to school basal reader stories, and reformatted trade book pages. The iPad gives River the option to zoom in, and adjust the size of images and text and reduce the complexity (Roman). Another advantage the iPad offers that paper does not, is backlighting. River, and so many other CVI learners, benefit from backlighting. Backlighting draws visual attention, and helps with visual fatigue.

Presently, River needs adaptations made for the complexity of the images and text. Word "crowding" is an issue with published materials and environmental print (complexity of array, Roman). He does not like finger pointing, and his visual battery for extended text passages is very short. Therefore I am always looking for ways to reduce complexity, limit unnecessary text and images, and stay true to the content being adapted. This presents a daunting task when the school reading book is an anthology of stories where the reading levels of the texts can vary greatly and the images can be quite complex.

There are many different iPad apps and websites that can be used to present text, images and activities to support CVI learners. Check out the CVI Teacher blog post by Ellen Mazel where she shares Matt Tietjen's suggestions on iPad apps.

Thanks go to Maryanne Roberto for introducing me to Google Slides. I will soon be using Bitsboard and other apps too.
Adapting Basal Readers
We have tried the following ways of adapting printed texts. When reading text, slant boards and book stands are consistently used to bring materials out of the lower visual field.

Here is a typical illustration and text from a beginning basal reading book. We can reliably predict that this illustration will make very little if any sense to a CVI learner. Sometimes the best thing to do is to block it out completely.

Font size, kerning and spacing may or may not need to be adapted.

Occluders and use of preferred color when "bubbling" words can be used.

(For River, the color "bubbles" were not helpful. The occluders were.)

Some stories have illustrations that are useful.

Increasing the font size, triple spacing between words (kerning), and double line spacing, the text was typed, printed and pasted on cards to use as shown. Font size and spacing adaptations will be unique for each CVI learner.

I have found the following sequence helpful to River:

1. The entire story is read to him. (Looking or not looking is his choice).

2. We identify the content of each illustration. I explain some, we talk about salient features of a few of the story items, and he asks questions about what he sees.

3. Word skills, reading the text, and comprehension activities all follow in lesson chunks.

All of this is NOT in one lesson. The "chunks" of literacy work are determined by River's visual battery and factors that affect his concentration.

"Partner reading" was a way of reading some of the stories and poems in the anthology. The teacher read the text as printed, and River read the enlarged text. (One of the objectives of this lesson was an introduction to poetry.)

When the text was replaced within the basal, word skills, salient features and spelling words were put in Google Slides to accompany the story.
Changes to Primary Phonics
Primary Phonics and Edmark Reading Program have been mentioned in CVI literacy blogs as programs that have been used with CVI readers.

(I happen to have some copies of Primary Phonics Storybooks that I have used with River). I have had no experience with Edmark Reading Program.

For some, the text is large enough to be read with or without occluders, finger pointing, or masking of lines.

(Whenever possible we use all the physical items that relate to the story to build background experience prior to reading. Salient features need to be emphasized, 2D Google images examined, and plenty of physical activity with the items to help build meaningful connections to the story concepts.)

Color can be added to assist the reader. This character's clothing and hair color was kept the same throughout the story.

If you cannot write on the book pages, you can put a clear (non-shiny) report cover sleeve over the text and write on it using a permanent marker.

(This is useful to do in any book when you want to draw attention to the salient features of something but you cannot write on the page.)

Following River's interests results in a wide range of literacy activities. We find magazine pictures and write sentences for them, use environmental print, and search the environment for words and images that are interesting and meaningful to him.

Google Slides are also useful when making adaptations to math worksheets. Most worksheet pages are crammed with information and organized in many different and difficult ways. Complexity is a huge issue with workbooks.
* Guest blog post by former educator, Judy Endicott. Judy is a reading specialist who taught in regular and special education classrooms, and worked as a reading specialist at the elementary level. She is also a Level 1 certified Wilson Reading Program teacher. Judy is the grandparent of River, who was diagnosed with cortical visual impairment (CVI) at 11 months old.
There is no one way to adapt materials for CVI learners. The best we can do is to share our ideas so we can learn from each other. Literacy opportunities are everywhere and a good reminder for all of us is to keep our literacy activities fun, short and meaningful for our CVI learners.

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Guest blog post by Judy Endicott When helping my grandson, River, who is almost nine, I know it is critical to use his CVI Range score (Roman-Lantzy), late Phase II, and information about his CVI characteristics as my guide to modifying his literacy materials. I always remind myself that what I can see and...

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In this video, Ellen Cadigan Mazel talks about color highlighting for children with Cortical Visual Impairment. Color highlighting really helps children with visual motor functions and for increased independence.

Children in phase II have a favorite color, it's very important for us to assess exactly what their favorite color is. Color highlighting helps determine where is this object in space.

Highlighting in the environment is also important. Drop-offs, steps up - all will really help the child move independently through the space.

Ellen also share her ideas for color highlighting to help children with CVI to reach and access their environment.
Read full transcript "
Transcript: Color Highlighting for Children with CVI
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MAZEL: Hi, my name's Ellen Cadigan Mazel, and I want to welcome you to this teachable moment. Today, we're going to be talking about color highlighting for children with Cortical Visual Impairment.

Color highlighting time becomes especially important as children enter phase II of CVI. And phase II is as measured on Christine Roman's CVI range. The goal in phase II is to function in the world, to reach, to access materials, to gain information, to build independence. Now that the child is exploring themselves in the environment, they're combining their sense of vision with hearing, touch, smell, taste, and getting a full multi-sensory idea of what's in their environments.

Students in phase II are beginning to use that more ventral stream vision, that detail vision that they need in order to function best in the world. They're sustaining gaze longer and are able to learn longer sequences. Using color highlighting really will help children use this ventral stream detailed vision most effectively.

So color highlighting helps with several things. First of all, it helps where is this object in space. Children with CVI will struggle with relative distance. So where is this object in space. Or what's the best place to grab this item or reach for this item? And how do I have something in my hand and put it into a smaller container or a smaller slot - again, that idea of relative space with vision.

Because children in phase II have a favorite color, it's very important for us to assess exactly what their favorite color is. For most of the things here today, I've used red as the color highlighting, but that's not always necessary. You have to really decide what the child's favorite color is. And I don't mean favorite color for their clothes. I mean what color draws their visual attention to the most effective degree. And that's the color we want to use for different children's highlighting.

So when we think about position in space, a child might have the activity where they need to put this on a blackboard in the classroom. The teacher wants them to take the symbol and put it on the blackboard in the classroom.

As the child gets close to the blackboard, they begin to drop this. They don't understand where is it that you want me to put this in space. So by simply creating some color highlighting on that board, the child understands, oh, that's where you want me to put it. And there it goes right on that board.

Now, once a child can do a task, we want to think about really removing the supports. So perhaps in the beginning, I take away one piece of the support, then the sides, and eventually the bottom, until they need no support for that particular task. So the idea is always to put the supports in place and then assess when you can pull those supports away.

When we think about what's the best place to grab, we want to highlight that for children. So on a lunch box, the best place to grab would be the top, to keep the orientation. If you want the child to grab their notebook, perhaps highlighting both sides of the notebook so these are the places their two hands will go to then carry it to their locker or carry it to the teacher's desk.

If you want them to pull down their own zipper, perhaps some color highlighting on the zipper will help them locate the zipper pull and be able to independently remove their coat. If I have the APH Spinner, the important part that I want the child to reach to is the tabs that will actually make this spin. That would be the salient feature I want the children to pay attention to.

As the children start to be independent with their ADL skills, I want them to know the best place to grab their brush. So I don't want to highlight the top of the brush. I want to highlight the handle. And again, we're thinking about reducing this support as the child gets the skill more and more solidly.

If I want children to turn on toys independently, I would highlight the switch that operates the toy. And again, as the child gets familiar with this particular toy, I can reduce this highlighting. I'm not leaving it in place forever.

When we think about children taking something and putting it into holes or into containers, we can use an all-done bin. And when we first began using the all-done bin, the children would not accurately put it inside the all-done bin. But color highlighting the edge really helped them understand where do you want me to put this. Where's the best place to put this. So color highlighting the edge becomes very important.

With the occupational therapist, she was using this pig, this musical toy pig. What's the most important part of this pig when you want to operate it? It's the slot. So once you've highlighted the slot, the child knows exactly where this material is supposed to go.

Red sorting trays - a child that you want to sort certain items by category - say, circles here, squares here - they have to know where each item is supposed to go. So just by color highlighting, this becomes very, very clear for the child where those materials go. And then they can show you their true cognitive skills.

As children get older, and they're doing an assembly task, color highlighting the different parts of the assembly task really keys them in to where in space the items go, where in space the items can be obtained.

Highlighting in the environment is also important. We might need to highlight door handles for children to get in and out of the room effectively. We might think about highlighting a chair so the child can move into a seat on their own. We might want to highlight the sides of walls going from one room to another, so the child has a distinct area that they understand that the space is going from one area to another. Any drop-offs get highlighted with some red highlighting or whatever the child's favorite color is. Drop-offs, steps up - all will really help the child move independently through the space.

For most of the materials that I highlighted here, I used red duct tape. This comes in many colors, so you can find this match to your child's assessed color preference. But you can also use what's called gym tape or painter's tape. The benefit of that is it removes easily. I know many of the schools that I work in don't want me putting duct tape all over their room so it's easy to remove. So that's an option, too.

So color highlighting really, really helps children with those visual motor functions and for increased independence. So we want to use it very thoughtfully and in a very targeted way.

Here's an example here. For color highlighting, I know the child's favorite color is green. The task is that the occupational therapist wants the child to pull on the tabs to untie this. So I'm not color highlighting the book. I'm not color highlighting the ties, the entire tie. I'm highlighting where I want them to reach. So again, thinking very thoughtfully about where do I highlight, what do I want the child to have their vision and their motor skills drawn to, is very, very important.

I hope some of these ideas for color highlighting have really helped you think thoughtfully about helping children with CVI to reach and access their environment. And that's today's teachable moment. Thank you.

For more information and other Teachable Moments, visit perkinselearning.org.

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Color Highlighting for Children with CVI

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In this video, Ellen Cadigan Mazel talks about color highlighting for children with Cortical Visual Impairment. Color highlighting really helps children with visual motor functions and for increased independence. Children in phase II have a favorite color, it's very important for us to assess exactly what their favorite color is.

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Teaching Students to Identify 2-D Pictures

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Teaching Students to Identify 2-D Pictures

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After students with CVI (Cortical Visual Impairment) have learned to view and identify real objects, they are ready to learn to identify two-dimensional pictures. It is essential to recognize the differences in a student's visual skill set before you begin. Specifically, the student may be beginning to look at bold, high contrast pictures in a book, but they are probably not identifying the pictures. Hopefully when students are participating in literacy activities they are exploring story box items and looking at the corresponding picture in the book. However, it is difficult to find books with clear, large pictures that match the real objects. This is why it important to use the story box items. When it is time to teach students how to identify pictures in a book, the activity should be different than typical story box literacy activities.

Assessment:

To determine if a student is ready to identify 2D pictures, observe how they are using their vision. If they are fixating on a 2D picture for intervals lasting for several seconds, then they may very well be ready. When a student is very interested visually in books, then they are definitely ready to work on picture identification. Remember that many children with CVI may not appear to look directly at things, and may be using their peripheral vision to look at something.

Preparation:

To begin teaching picture identification, select several (between 2-5) objects that the student is familiar with and easily identifies. Choose meaningful and purposeful objects, such as their favorite toys, cup, spoon, ball, book etc. Cut up pieces of black foam, invisiboard, or black poster board to "mount" the object. Take pictures of the real objects and mount them also. Now your materials are ready for your activities. Materials can also be prepared to be used within a calendar system.

Pairing:

Before you begin the activity, have the object and the black backing. If you are about to play ball, touch, explore and identify the ball. Then put the ball on the backing, touch and explore it on the board. Give the student ample time to visually locate, and look at the ball alone and against the board. Play with the ball for a few minutes, and then again look at it on the board. Repeat this at least twice during the activity. When you stop to look at the board, communicate with the student. You can ask, "Would you like to kick the ball or throw the ball?" Be patient with the activity. The student may or may not look at the card. Eventually the student will look, gradually increasing their fixation. The student may reduce the processing time needed to identify the object. Once you have established that they can identify the object on the card, it is time to pair the object card with the picture card. Continue as you did before, showing the object card and the picture card before you engage in the activity.

Lesson Planning:

Embed the activity within your lesson plan. When the activity is fun and meaningful, the student will enjoy learning (and possibly learn more quickly). Choose one or two objects to start with. Look for opportunities throughout the day to use the objects. For example, if you are teaching the student to recognize a ball, use it when it is time to play ball. If the student is ready, focus on two objects during the day.

Supplemental Activities:

As the student learns to identify pictures, you can make him/her a vocabulary book or story. Glue one picture on each page and either bind it or put it in a notebook. You can even write a sentence or two about each object. Include your student in this activity and encourage as much participation as possible. Sample: You are writing a sentence about a favorite toy drum. You can ask the student questions about the drum to help you format your sentence. "Alexis, do you like to play the drum with your hands or your feet? Which song do you like to sing?" Your student may answer by moving their hands or feet, vocalizing, or using a voice output device. Then write the sentence with your student sitting there (using print or braille). The text would read "Alexis plays the drum with her hands. She sings 'Ocean Drum' while playing." Each page in the book can be just about the object or there can be an overall theme to the story. A common theme is "My School Day". The pages would reflect the student's activities. The text would read "I play the drum during music. At PE I kick the ball to my friends. During art I paint with my paintbrush." Again, involve the student in writing the story. Keep the book in your literacy center for additional review.

Another technique is to create a book with an object that can be moved from page to page. For example, one year when my class read "The Very Hungry Caterpillar", we made a moveable "caterpillar" from a pipe cleaner. On each page, we could Velcro the caterpillar to the page. This allowed the student to manipulate and move the object, and then view it against a solid background.

School-Home Connection:

Share the book with the student's family. Explain the purpose behind the book and the process you took to teach picture identification. Either send the book home with the student, or encourage the family to make one for home. Sometimes it is easier for the family if you send home the materials (such as blank pages bound together). Students can bring the books in as part of show and tell, or simply to share with you.

Evaluation:

Some students may work on the same two picture identification for the majority of the school year. Evaluate whether the student needs the repeated opportunities each day, or if your strategy/technique needs adjustment. After working on the activity for a few weeks, determine if they can identify the picture. Show them two pictures and tell your student, "It is time for art. Find the paintbrush". When they look at (and or reach for) the correct picture consistently, you can feel confident they have learned to identify that picture. Continue teaching meaningful pictures with real objects. Eventually, the student may be ready to identify more abstract pictures.

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Teaching Students with CVI to Identify 2-D Pictures

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After students with CVI (Cortical Visual Impairment) have learned to view and identify real objects, they are ready to learn to identify two-dimensional pictures. It is essential to recognize the differences in a student's visual skill set before you begin.

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Using information obtained from Christine Roman-Lantzy's book, Cortical Visual Impairment, An Approach to Assessment and Intervention, these books are designed to help bring literacy to students who are diagnosed with or demonstrating the characteristics of CVI.

It is important to remember that when introducing new information to a student, it is usually best to go back down a Phase level. Ex: student is functioning at Phase III but when a new math concept is introduced, ensure that the materials are presented in a Phase II format for ease of visually attending and learning.

Phase I - Building visual behavior

Objects viewed are generally a single color, have movement or are reflective

Prolonged periods of visual latency

Distinct field dependency

May respond only in strictly controlled environments; does not attend to faces

Overly attentive to lights

Visually attends in near space only

Latent or no response to touch or visual threat

Resistant to novel objects

Look and touch occur as separate functions

Phase II - Integrating vision with function

Objects may have 2 or 3 colors and movement may continue to be an important face to initiate visual attention

Latency only when student is tired, stressed or overstimulated

Field preferences decreasing

May tolerate low levels of familiar background noise; may regard a face without the voice

Light is no longer a distractor

Visual attention may reach a distance of up to 6 feet

More consistent response to touch and visual threat

Begin visual time with familiar objects but can move to novel ones

Look and touch occur simultaneous with familiar objects

Phase III - Resolution of CVI characteristics

More colors recognized and familiar patterns

Movement not required to gain visual attention

Latency rarely present or resolved

Visual fields unrestricted

Competing auditory stimuli tolerated during period of viewing; student may now maintain visual attention on musical toys

Smiles and regards familiar and unfamiliar faces

Visual attention extends up to 10 - 20 feet

Visual reflexes consistently present

Selection of objects not restricted

Look and touch occur in rapid sequence or together.

Sample Books Created for Students with CVI

Books that were created were done so with specific students in mind. However, the books, or at least the idea behind them, may be used with other students. You will need to assess your student and determine which books and modifications will be most appropriate. These were printed at the GPAEA Print Shop in Ottumwa, using card stock for the paper so that the pages are durable and the images on the reverse side are not easily seen through the paper. A coil binding is used as a binder.

An extra copy of each book that was provided to a student at school was made and sent home with the student. This provides reading material the family can use at home that will benefit the child.

Sample Books

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 - No words in this book, only different shapes with color combinations. This book may also be used in a higher Phase level to determine color preference, shape recognition, determine field preference, positional concepts, assessment of visual tracking on the page and counting.

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.

Circle and Red Triangle - Simple story of a yellow circle and a red triangle who like to play together. Words are on the same side of the page as the pictures, but these can be moved to the opposite page if desired. Concepts of top, bottom and sides of page can be incorporated.

These books incorporate words on the page with the pictures. Once these books are familiar to students, many of them are paired with objects that represent the pictures in the book. This seems to help students understand how pictures represent real objects. Books to consider:

The Body Book - This uses simple shapes to create a 'stick' body. An extra copy of the last page of the book can be made, then cut out the shapes and use as a puzzle to build the body. Place a blank sheet as a final page and an envelope can be glued to it to hold the puzzle pieces.

Bill the Duck and the Ladybug - Bill makes a re-appearance in the same story but the words are on the same side as the pictures. A plastic duck and ladybug are paired with this story.

Playful and Colorful Kittens - What is more fun than kittens? Most pages have one kitten playing with a ball of yarn; each kitten and yarn ball are in a different color. The student this was created for has a love of kittens so the subject matter really attracts her visual attention. Soft, stuffed kittens, along with a ball of yarn, are paired with this story.

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.

These books incorporate more background information but the primary focus remains on the subject.

Curious Christmas Kitty - This was created for the student who loves kittens so it could be incorporated into the Christmas readings at her school. Simple story of one little kitten and her Christmas adventure. It allows the book to be customized with the student's name on the stocking. Using the interest of this student has encouraged her visual attention with more complexity, for longer periods of time.

All About Popcorn - This was created to be used by a student whose class was reading a book about the same subject but it was too busy for the student to attend to visually. More advanced story line, with more words on each page. This book increases the amount of story line; using questions at the end can help determine comprehension of the student. Send one home and the family can read it together then pop some popcorn to enjoy.

Finding Pyper - This is a book created for a student to practice recognizing the letters of her name. It has much more background but the letter is large and separated, allowing her to practice her visual skills while locating her letters and name.

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Books for Students in Different CVI Phases

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Using information obtained from Christine Roman-Lantzy's book, Cortical Visual Impairment, An Approach to Assessment and Intervention, these books are designed to help bring literacy to students who are diagnosed with or demonstrating the characteristics of CVI. It is important to remember that when introducing new information to a student, it is usually best to go back down a Phase level.

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Introduction:

For my Cortical Visual Impairment mentor training we were assigned to adapt a book for all three phases of CVI. I chose The Very Hungry Caterpillar because I have several classes reading this book through the end of the school year. I wanted to adapt something that could actually be used with my students. The two classes with Phase I, II, and III students are both self-contained moderate/severe or severe/profound classrooms.

*All three phase adaptations would have a script for salient features of each item from the book. The salient features of an object are the defining facts or qualities about that object such as an apple being red, round and having a brown stem or a caterpillar being small, green, and soft. The team working with a child would decide upon specific salient features of each object or picture presented to a student and would all be sure to describe these salient features in the same way for consistency.

Phase I Adaptation:

For a low phase I child you can do one of three things (remember to focus on only one sense at a time with a CVI child!). Dr. Roman-Lantzy recommended using shiny/mylar paper in the colors of the fruits and presenting them one at a time to the student and stating that "an apple is red" or "an orange is orange" and so on. This paper is readily available and can be found inexpensively at the Dollar Tree. You can use sheets found in the craft section, wrapping paper, "tissue" paper, or even gift bags.
Begin by using real objects, such as real fruits and vegetables. Allow the child to explore these tactually and visually, perhaps to taste them, cook with them, etc., so that the items have meaning.
They could also either utilize another single sense during story time, either by only tactually exploring the object or listening to the objects salient features described. For this purpose, I located real-like 3-D objects to represent each of the items from the book.

In the early stages of Phase I, these will be too difficult for the child as they will be not be able to visually attend to more than one or two single solid preferred colors and multi-colored objects will be too complex. Begin with the objects that are single color and in their preferred color such as the strawberry or caterpillar. As they begin to recognize additional colors, you could begin to incorporate more of the 3D representations. Each will be presented against a solid black background with light shown on them or by putting them on a light box in a lower lit room.

Phase II

You would continue to use the 3D objects in the beginning of Phase II until the child has resolved to the stage that they are ready to view 2D materials. I took photographs of each of the 3D objects so the student could begin to match the 3D object to a 2D photograph of the object.

These could also be viewed on an iPad to take advantage of the backlight if needed.

I then took photographs of the items from the book, cut them out and bordered them with mylar paper. They can then begin to connect the 3D object to the 2D illustration from the actual book. I put a mylar border around each to draw their visual attention to the picture. The teachers will talk about the salient features that are common between the 3D and the 2D illustrations from the books. At this point the teacher would want to talk about additional salient features that the 3D objects might not have had, like the legs, eyes and antenna on the caterpillar or the green stem on the strawberry.

Phase III

I then made black card stock "windows" of differing sizes to be able to block out the rest of the page and focus in on one illustration. The teacher would begin by using only the adapted book and then begin to incorporate transitioning to the actual book using the window to show the student where the item is on the page. This would hopefully help them learn to locate the item on the original page. Again, be careful of glare if laminating materials.

Happy book adapting!

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Adapting Books For Children With CVI At All 3 Phases

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For my Cortical Visual Impairment mentor training we were assigned to adapt a book for all three phases of CVI. I chose The Very Hungry Caterpillar because I have several classes reading this book through the end of the school year. I wanted to adapt something that could actually be used with my students.

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Strategies for Improving Literacy Skills

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Strategies for Improving Literacy Skills

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Overview and Implications for the 3 Phases

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Overview and Implications for the 3 Phases

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By Diane Sheline, TVI, CLVT

Children with cortical visual impairment (CVI) present a unique challenge to educators and families, and many wonder what the impact is on the development of literacy skills. The information presented here is designed to be an overview of some of the implications of the CVI Range for literacy, with specific strategies for children who visually function in each of the three phases of CVI. Also included are general guidelines for creating books for children with CVI, as well as specific guidelines for each of the phases. Special attention is paid to the identification of salient features.

I am often asked the following from parents and teachers of children with CVI, "What are the best books I can get for my child/student who has CVI?" I always respond with a question of my own, "What is your child's level of visual functioning on the CVI Range?" Because children with CVI have very distinct needs depending on which Phase they are visually functioning in, it is of utmost importance to know the child's visual functioning level on the CVI Range and how specific behavioral characteristics affect them. This must be known prior to purchasing a premade book or creating a book for the child to learn from. For example, a book with a variety of multicolored, abstract cartoon-like illustrations on each page wouldn't be appropriate for a child who visually functions at the beginning of Phase I and is just starting to use vision. But with knowledge of assessment results and careful consideration of each child's specific preferences and needs, a collection of books can be made which encourage looking behavior, interaction, interest and develop pre-literacy skills.

In addition to knowing the child's level of visual functioning on the CVI Range, you want to have a good understanding of what the child is interested in looking at! To make reading fun, you need to incorporate what the child loves, into the books. Pre-literacy and literacy activities need to be enticing to a child, to the point that they look forward to and want to interact with books. The best way to start off is in knowing what the child's preferred visual target is. Parents are often the most knowledgeable in this area. They know what objects and targets the child looks at most frequently and often, the real, concrete object (or part of it) can be used in a book. Having a clear understanding of the child's preferred color and tying it into or along with the preferred object is also crucial, especially for the child who visually functions in Phase I.

My methods of creating books and the examples of books which I share are primarily designed for very young students with CVI, in the birth through 5-year-old range (although they could also be used with older students with CVI). Since every child with CVI has unique needs, the sample books I share are simply examples; each student requires appropriate materials which match their individual needs. My hope is that these suggestions (and my sample books) will spark your imagination, and help guide you in creating literacy that will work for your child or student.

Please refer to Adapting Books and Literacy for Students with CVI for ideas of sample books to make. Please refer to Materials Used for Adapting Books and Literacy for Students with CVI to see a listing of materials I used to make the sample books.

Follow these general guidelines when creating books for students with CVI:

1. Always have a clear understanding of your child's or student's CVI Range score and the behavioral characteristics they demonstrate, which will guide you as to how best to create the book.

2. Make reading time fun by using the child's preferred, favorite targets that are interesting and enticing to them.

3. In most cases, it is best to use a solid colored background for the pages which makes the target really "POP". While students may not have ocular issues resulting in reduced contrast sensitivity, nevertheless they do benefit from having a solid colored background that makes the target stand out or "hides" complexity in the array. I have had the most success creating books with pages of black, heavy cardstock. See the Materials section for more information on this.

1. When I make up stories about a student's favorite visual target used in a book, I often "read" the story to the tune of other well-known jingles, such as, "Ten Little Monkeys Jumping on a Bed", "These are a Few of My Favorite Things" or, "The Itsy-Bitsy Spider".

2. If the child has difficulty with competing sensory complexity, they may not be able to look at the book/targets and listen to the story being told at the same time. Look at the child's assessment results to determine if reading the story (while the child is looking) is appropriate. It may helpful to wait until the child glances at or looks at the target and then you say, "I see that you are looking at ____" and include 2 or 3 salient features along with a bit of a story. For an example of this strategy, see the sample book, "Where is the Red Gift Bag?". The important key here is waiting until after the child has looked (or is looking) at the target, then you can speak.

3. If the child has difficulty with visual complexity (looking at more than one target in an array), you may not want print on each page. See Adapting Books and Literacy for Students with CVI for strategies to use regarding the use of print.

4. Use "Page Fluffers" to separate pages. This makes it easier for little fingers to help with turning pages. A "Page Fluffer" can be created by sticking a clear, round, self-adhesive rubber pad bumper to the top, right corner of each page (or be creative and use an alternate "Fluffer" of your choice). See the Materials section for more information on this.

1. Resist the temptation to laminate pages. Lamination causes glare and many students with CVI will not use their vision (or not consistently) if the target is producing glare.

2. Use Blocking Techniques when there are too many targets on a page or if print is used and causing additional "visual clutter". The easiest Blocking Technique to use would be to have a sheet of heavy, black tag board, cut into various sized rectangles. Use an appropriate sized piece of this black paper to block off print or other "visual clutter" from the child's view.For an example of this strategy, see the sample book, "One Yellow Slinky Bouncing Up and Down".

Use SpotLIGHTing Techniques to draw visual attention to specific targets in a book (see the book, "Strategy to See" or website for ideas on SpotLIGHTing).

1. When a book is made for a child, make sure to send it home/to school so the child has literacy opportunities throughout the day. Better yet, make two copies of each book; one for school and one for home. The more the child is exposed to books, the better!

2. Be very careful when considering use of pictures in books. Some children who visually function in Phase I and Phase II may look at books with pictures, but it is often the bright colors (or possibly a reflective quality) they are looking at rather than demonstrating an understanding of the picture itself. While all looking behavior is positive, especially when in Phase I, sometimes the complexity of the picture may cause the child to look away or close their eyes. It has been my experience that children do not start to have a clear understanding of what a picture is and what it represents, until they are visually functioning at approximately 6 on the CVI Range.

3. One important idea to keep in mind when working with a child with CVI (all Phases) is that there needs to be consistent and frequent collaboration between all early intervention team members. This may include (but is not limited to) the parent, teacher, TVI, COMS, PT, OT and Speech Therapist. The entire team needs to understand the child's specific behavioral characteristics and how to best adapt materials, where to present materials, and what specific script is being used when discussing salient features. Having the entire team "on the same page" insures that the child can use their vision consistently throughout the day.

The importance of identifying the salient feature(s) of the object or visual target is discussed by Dr. Christine Roman-Lantzy in her book " Cortical Visual Impairment; An Approach to Assessment and Intervention ". A salient feature is a defining fact or visual quality about an object or target that is presented. Salient features may include color and shape but also includes specific features unique to that target. Describing a target's salient features helps the child to visually locate it from the background or surrounding environment. Mentioning the salient features can be a cue to draw the child's visual attention to the page, to look for the key target. A few ideas to remember when planning on incorporating the use of salient features to the targets of your book include (but are not limited to) the following:

All members on the child's early intervention team should decide on the specific salient feature(s) of the main (repeating) visual target on each page or the salient feature(s) of each object or picture presented on each page. Everyone should describe these salient features in the same way. It is often helpful to have a script for each book, to remind readers to use the same vocabulary when mentioning the salient features.

Early on, when your child demonstrates looking behavior towards a specific, favored target (for example, a red Clifford dog), attach a mylar ribbon "collar" (in the child's preferred color) and point out the ribbon consistently as a salient feature when your child plays with the toy. Then, later when books are made, you can carry over that mylar ribbon "collar" by actually incorporating it into your book (paste a small strand of ribbon around Clifford's neck in each picture). It can then continue to be used as a salient feature which your child visually searches for. For an example of this strategy, see the modified book, "Clifford's Family".

Alternately, there may be some unique, specific quality about the child's favorite target which you can carry over and use as a salient feature in books. For example, if your student or child's favorite "toy" is a silver pie tin, you could cut up a pie tin (or use a miniature pie tin) and combine it in some way with the larger target which is reoccurring throughout the book. Since the bright, mirror-like quality of the pie tin already draws the child's visual attention, you can use this as a salient feature of the larger target to help the child visually locate the target and explore it more fully.

Dr. Roman recently pointed out that, "The salient features of a target should include 2 or 3 descriptors, but not more", and, "The salient features of a target should be true, or nearly always true, of the target".

See also:

Examples of Books

The following are examples of books I have created for students with CVI:
For more ideas from Diane Sheline, visit Strategy to See.

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Literacy for Children with CVI: Overview and Implications for Different Phases

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By Diane Sheline, TVI, CLVT Children with cortical visual impairment (CVI) present a unique challenge to educators and families, and many wonder what the impact is on the development of literacy skills.

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A variety of resources and strategies to increase literacy skills in students with CVI...

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Sample FVA with CVI Characteristics for Owen M.

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Sample FVA with CVI Characteristics for Owen M.

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An assessment of the child's use of vision is important for determining current abilities as well as the interventions that will provide visual access.

This resource binder primarily uses the work of Christine Roman-Lantzy, who created an approach to assessment called the CVI Range. The assessment and intervention guide contains all the forms, procedures, and intervention strategies and is located on the next sub tab.

The other sub tabs contain forms and examples you might find useful when conducting the assessment and writing the report to share with the team.

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The following are suggestions to use with infants, young children, and students who have Cortical Visual Impairment (CVI) or who are suspected to have some other form of brain damage related vision loss.

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Strategies for Students with Cortical Visual Impairment (the handout)
Formally titled, "Encouraging Efficient Use of Vision in Students with CVI"

The following are suggestions to use with infants, young children, and students who have Cortical Visual Impairment (CVI) or who are suspected to have some other form of brain damage related vision loss. These suggestions are intended to encourage students with CVI to use their vision more efficiently and consistently. The suggestions are broken down into basic, Level 1 Strategies, intermediate, Level 2 Strategies, and more advanced, Level 3 Strategies. These 3 levels of strategies correlate loosely with the 3 visual functioning Phases of The CVI Range described by Dr. Christine Roman in her book, Cortical Visual Impairment - An Approach to Assessment and Intervention. It is important to read through all suggestions and strategies, as some students may benefit from suggestions from two different levels. For example, if a student is visually functioning in Phase I on The CVI Range, he/she may benefit not only from Level 1 Strategies, but possibly also Level 2 Strategies. Use the suggestions, especially the Strategies in Level 1, in conjunction with regularly occurring activities in daily life such as feeding, toileting, grooming and amusement activities. These are general guidelines; no individual student with CVI will ever fit into any one category. More importantly, these suggestions will hopefully spark ideas of your own so that you can modify materials and create individualized lessons specially tailored for your specific student or child.

The following is only a partial listing of strategies. Please see Diane Sheline's book, Strategy to See: Strategies for Students with Cortical Visual Impairment for a detailed listing of strategies (with color photos of materials), the CVI Skills Inventory and Strategies Worksheet, strategies for literacy, Interview Forms, SpotLIGHTing Techniques and more.

General Considerations - Level 1

Students who benefit from Level 1 Strategies are generally just starting to use their vision. They often alert to light (or light sources), single - brightly colored objects, slow moving targets and bright walls. Environmental and sensory competing input often needs to be eliminated (or at least reduced) when the student is trying to use his/her vision. The visual target often needs to be close, within arm's reach and usually the student needs the viewing array limited to one or possibly 2, widely spaced targets only.

Students who benefit from Strategies at Level 1 often need high contrast between a single target and its background. They often alert most frequently to targets presented at their far left or far right, eye height. Rarely do they alert to targets in their lower visual field. Often, they prefer to look at objects and targets that they have looked at over and over again (familiar targets). Visual fatigue is often a problem and many students have difficulty with eye/hand use.

Repetition, repetition, repetition: use the same objects and the same process each time to provide familiarity, reduce latency period, and shorten "warm up" time

Having the same individual(s) working with the child in the same way, again and again is often helpful.

See, "Steps for Incorporating Activity Routines into Your Practice" at: http://www.tsbvi.edu/seehear/fall02/activity-routines.htm

Repetition and practice is how a child with CVI learns to integrate new knowledge, remember it for a future session, and put it to use.

Use the CVI Skills Inventory & Strategies Worksheet to help you determine the best strategies to use with your student.

Interview the primary caretaker or parent

If the assessment or evaluation occurs away from home, encourage the caretaker/parent to bring the student's favorite, most viewed targets from home.

Be aware of prescription medications the student takes; some may cause the student to be drowsy and/or have visual side effects.

Watch for signs of visual fatigue, overstimulation and/or stress.

Slow down presentation of visual objects and targets. Allow the student time to process what is being seen and respond to what is being presented.

Allow for intermittent break times.

Plan activities for the time of day when student is alert, ready to learn.

If student is not alert, ready for action, help to wake him/her up by using voice or tactual stimulation (my favorite is a tubular vibrator or vibrating "snake").

Proper positioning is crucial. Work closely with the student's PT and/or OT to determine the best position for your student to be in. The student needs to feel safe and secure but also in the best position to allow him/her to interact with visual targets.

If your student is starting to become mobile, use lights (or lights shining on objects or mylar objects) to encourage reaching behavior and movement.
Environmental and Sensory Input - Level 1
Reduce auditory distractions when visual learning is taking place - turn off the TV, turn off the radio, move away from neighboring students who are very vocal/loud, turn off cell phones, encourage quiet from other adults/caretakers in the room.

A student who uses his/her auditory learning channel quite efficiently, but who has to work very hard to use their vision and make sense of what they are seeing, will often just listen to auditory input rather than work hard to use their vision. For example, if the television is on and a singsong program is playing, it may be that the student with CVI will want to only pay attention to the auditory and ignores or "shuts out" what is presented to him/her visually. If the television is turned off, he/she may then use the vision channel.

Reduce tactual distractions when visual learning is taking place - resist the temptation to give a rub on the back or a pat on the arm as a "good work" gesture; Care should be taken not to bump into a wheelchair or bed. When there is a need to encourage the student to touch something, use hand-under-hand technique - more information at: "The Language of the Hands: Hand-Under-Hand Technique" http://nationaldb.org/NCDBProducts.php?prodID=47

Reduce or eliminate visual distractions that may interfere with visual attending behavior (i.e. sudden movement off to the side). Use a 3-panel curtain or room divider to block off distractions or use positioning techniques. For example, turn the student so they are not facing the visual distractions.

Use a white or black cloth to cover distracting background items. A black king sized sheet works well for this. Keep one in your Functional Vision Evaluation kit or handy to use during lessons.

Walls and bulletin boards should be simple and free from clutter. Use 3 or 4 paneled curtains or room dividers to block busy visual input or cover with a black sheet when visual learning is taking place.

Carpets should be plain, no pattern. Toys and materials often "blend in" on a patterned carpet and the student can't locate them. Use a solid colored mat or a large piece of black headliner fabric, which is Velcro-compatible and washable.

Turn the student away from sunlight streaming through windows or blinds. Non-purposeful light gazing may distract the student.

Care should be taken that no bright sparkling or flashy jewelry is worn, distracting the student from the visual target.

Teacher or caretaker/parents should wear plain colored clothing, preferably black. Glittery fabrics or sequined clothing will be visually distracting. Use a black smock to wear while testing or working on skills.

Eliminate strong smelling odors or harsh perfumes. This includes strong smelling foods cooking in the kitchen, which may be difficult when working in the home environment of some children. Some perfumes, aftershaves and deodorants are particularly strong smelling and may not only distract a student who is just beginning to use their vision, but also become offensive.

Maintain a comfortable room temperature.

Reduce or eliminate oral distractions such as finger sucking or use of a pacifier.
Near/Middle/Distance Viewing - Level 1
Students who benefit from Level 1 Strategies, generally benefit from all visual targets presented at near or no more than 12 to 36 inches away.

Use of a custom made slant board, reading stand, felt covered tri-fold board or angled dry erase board are helpful in bringing targets into the near visual field (and also creates contrast).

Present visual targets in the preferred, near visual field, usually far left or far right, at eye height.

Often students have difficulty detecting visual targets in their lower visual field - raise targets up to eye height in the near visual field.

Using a magnetic cover/protector on the iPad flipped backward and over the All-In-One Board (attaching it to the white magnetic side) allows the iPad to "hang" from the All-In-One Board at a slant. This will allow the student to get close to the iPad*.

*Caution: Very near viewing of an iPad by any student who has a programmable valve setting in their shunt should be avoided. Since external magnetic programming tools can change programmable valve settings by interacting with a magnetic rotor inside the valve, use of an iPad at close range (less than 3 inches away) is not advised. Several studies have suggested that exposure to tablet devices, such as an iPad, may alter programmable shunt valve settings.

Gradually increase the distance the student is viewing targets when using their favored toys or objects during play or typical daily routines. Adding movement will help the student visually attend for a longer period of time.
Visual Target - Level 1
Use single colored objects, especially in the colors red or yellow. Sometimes, other bright primary colors including fluorescent colors, work well.

Pair visual target with movement (i.e. a solid colored slinky), especially in the peripheral fields; sometimes, movement of the object helps the child to see it better.

Use visual targets with light qualities, either SpotLIGHTed or lighted within.

Use visual targets with reflective qualities (i.e. a mylar pom pom).

Use visual targets that have movement qualities (i.e. slow moving slinky).

Present one visual target at a time.

In some cases, pairing visual targets with sound will initiate looking behavior (i.e. an auditory cue).

In some cases, pairing visual targets with a touch cue will initiate looking behavior (i.e. a touch cue).

Use real objects whenever possible. When using an Anticipation Calendar, use real objects that the child has had a meaningful experience with (see http;//www.tsbvi.edu/Outreach/seehear/archive/Let Me Check My Calendar.htm) For example, use a real cup rather than a picture of a cup. Relate what is being seen to function, whenever possible.

Present real objects against high color contrast (light colored foods against dark plates with a contrasting background color)

Watch for subtle response cues to visual targets including; shifts of gaze or body positions, changes in breathing patterns.

Use color:

Keep color of common objects consistent until an association is established (if the student is attracted to red, use a red cup during meals; at school and at home)

Encourage looking at faces by creating sharp, contrasting "edges"; use bright red lipstick, red steady light or blinking glasses, or use red, mylar-like material to create a head scarf

Bright, primary colors or fluorescent colors often work best; red, yellow, purple and orange often work well

Observing and discriminating the human face is an area students with CVI often have difficulty with. Researchers have found that newborn infants tend to look at high-contrast borders of objects (University of Michigan, 1970). When looking at the human face, a newborn might look at the hairline or edge of the face. But by 2 months of age, infants should start to look more at internal features of the face (the eyes and mouth) and by 4 to 5 months of age, they can generally recognize their caregiver's face. Therefore, for our students with CVI, we need to first encourage looking behavior towards high-contrast borders. If mom or dad has very light hair, maybe use of a dark color headband or head wrap would help. Once the child starts to look at the hairline or edge of the face (the high contrast edge or "border"), accentuate the eyes with light up glasses, the nose with a red, foam clown nose or mouth with bright red lipstick.
Spatial Window of Visual Attention or Visual Array - Level 1
Students who benefit from Level 1 Strategies, will need to have a very limited array - one or no more than two visual targets at a time. Usually, it is helpful for the target to be brought up into the field of view. Do not present the targets flat on the table until you are certain that the student is able to successfully view targets in the lower visual field.

If two visual targets are used, there should be wide separation between the two targets.

Work surface should be free of visual clutter. This includes cell phones (and turn off the ringer so the auditory does not distract the student), car keys and other miscellaneous items.

The work surface behind the target should be a solid contrasting color.
Contrast - Level 1
Teacher and caretaker should wear plain colored clothing that creates contrast behind the target being presented.

Wearing a black smock or black apron works well.

Use a black cloth or king size black sheet to cover distracting items in the background. For example, you would want to cover a full bookcase when it is behind a visual target; cover the "visual clutter".

Use a black felt board, APH Invisiboard or APH All-In-One Board when targets need a Velcro compatible background.

Using a white cloth or white sheet will also create contrast for darker targets.

Create a "CVI Den" to reduce visual distractions and create contrast. A CVI Den can be made from a variety of black, tent like structures. For example, a child's pop up tent, lined in black headliner fabric often works well. Visual targets are then placed inside and on the sides of the CVI Den.

Do not present objects or materials in front of busy patterns with complex colors.
Preferred Visual Field - Level 1
Present visual targets in the student's preferred visual field - this is usually the far left or far right peripheral field for students who benefit from Level 1 strategies.

Students using Level 1 strategies generally do not prefer targets to be presented in their central field of view.

Students using Level 1 strategies often have difficulties when targets are presented in their lower field of view. When students have difficulty-detecting targets in lower visual field - raise targets up by using an All-In-One Board from APH.

The student may turn his/her head to one side or the other when reaching for an object; it appears as if they are looking away from the visual target, but they may be using their peripheral vision.
Lighting - Level 1
Provide additional, supplementary light shining on target of interest; 100 LED bright flashlights work well or flashlights with at least 250 lumens.

Use SpotLIGHTing Techniques (See the book, Strategy to See).

Shine light on target of interest without attracting student's attention to the light source.

Do not shine a bright light into the eyes of the student, only on the target.

Use of plug-in, natural desk lights work well to shine on targets and workspace (but you are restricted to the length of the power cord).

Use of Light Box (with a Swirly Mat from APH) and other lighted toys/targets are beneficial.

Use of a Perkins LightAide has been found to be very motivating for students who have CVI.

Care should be taken when using blinking or flashing lights (this sometimes sets off a seizure).

Use brightly colored, lighted balls to attract attention. A red 100 Light Holiday Super Sphere or a colorful Puzzle or Jigsaw Light both work well for the student just learning to use vision.

When using a supplementary light shining on a target to encourage visual attending behavior, dim the overhead lights and reduce natural light coming through windows.

Using black gloves with lighted fingertips has been an excellent way to encourage looking behavior for the student who is just beginning to use their vision. Use a black colored background (like an Invisiboard) and once the glove is on the hand, slowly wiggle the fingers. Bring it from the far left or far right slowly towards the central field of view. Keep this target within 18 inches of the student's face. Dimming the overhead lights and wearing a long sleeved black smock really makes the lighted fingertips stand out!

A small number of children with CVI experience photophobia (light sensitivity). Watch for this and reduce the intensity of light if this is a problem.
Familiarity - Level 1
Teachers, parents, caretakers and others working with students who are just beginning to use their vision should have a good understanding of the familiar, favored visual targets the student will visually attend to. Completing a thorough Parent Interview will be crucial in gaining a good understanding in this area. Using these favored, familiar visual targets will increase looking behavior and can be used to "warm up" students prior to working with them using other visual targets or work on new routines.

General Considerations - Level 2

Students who benefit from strategies at Level 2 are generally using their vision more consistently, but often not efficiently or for a purpose. The parent, caretaker and/or teacher will want to work towards encouraging the student to use their vision during daily routines and activities, such as when eating meals. Students who benefit from Level 2 strategies often can tolerate low levels of familiar background noise/voices and minor tactual input when using their vision. Targets can sometimes be up to about 4 to 6 feet away (depending on size of the target and the color/contrast) and students can now attend to several well-spaced targets in more than one color.

Contrast between target and background for the student who benefits from Level 2 Strategies continues to be important, but generally, the student can tolerate more patterns at near. They also often attend more frequently when targets are presented not only at far right and far left, but also centrally. Lighting continues to draw the student's visual attention and can often be used to encourage interaction with objects for functional purposes (i.e. Sippy cup that lights up). At this stage, it is often helpful for some quality that the student favored in Level 1 to be carried over to enhance Level 2 Strategies. Visual fatigue is often still an issue and positioning needs to be monitored.

Many of the same considerations for a student who benefits from Level 1 Strategies applies to a student using Level 2 Strategies, including;

Use of Interviews (Parent, Caretaker, Teacher, etc.)

Awareness of Rx Medications

Awareness of times of day when student is most alert, ready to learn

Since students using Level 2 Strategies now are using their vision for more functional purposes, it will be important to look closely at the student's daily routines, both at home and at school, to determine appropriate accommodations.

Verbally note salient features when discussing visual targets ("The ball is yellow and round").

Be careful with, or avoid use of, pictures. Generally, a student who benefits from Level 2 strategies needs real, tangible targets (3D). Switching to 2D targets or pictures is often difficult. Color photographs of familiar, favored targets often work best during this process.

Providing a routine and structure/sameness continues to be important.

Observe student carefully to make sure the presentation of visual targets is not too fast; allow the student time to process what is being seen and to respond to what is being presented.

Use of cues, signals and symbols might be considered at this stage (see "Non-Verbal Communication: Cues, Signals and Symbols" at; http://www.tsbvi.edu/component/content/article/1725-non-verbal-communication-cues-signals-and-symbols

Encourage students to learn through Dr. Lilli Nielsen's Active Learning http://www.tsbvi.edu/component/content/article/136-intervention/3415-active-learning-resources
Environmental and Sensory Input - Level 2
Reduce auditory distractions; turn off the TV, turn off the radio, move away from neighboring students who are vocal/loud, turn off cell phones, encourage quiet from other adults/caretakers in the room.

When an auditory cue is used/needed to encourage looking behavior (and develop language), use the following suggestions;

Clearly explain, in a few simple words, what it is that you want the child to look for and where to look; use "Verbal Cuing" ("The ball is by your foot").

Use descriptive words about the object or visual situation ("Shiny red light").

Use voice intonation that matches the word used

Use an interesting noise or a few words of praise, along with a visual target, to increase looking behavior (crunchy/scratchy noise when you shake a mylar pom pom)

If possible, try to establish looking behavior first, then give verbal praise or description; make sound a "reward" for looking behavior

Reduce tactual distractions when visual learning is taking place;

Resist the temptation to give a rub on the back or a pat on the arm as a "good work" gesture

Avoid grabbing a hand to help student touch something

When a tactual cue is needed to encourage looking behavior, keep in mind the following suggestions;

Touch the object of interest to the child's hand to direct visual attention

Run the object of interest down the side of the child's arm to his/her hand, to direct visual attention

Reduce visual distractions when visual learning is taking place;

Sunlight through the window or light from a lamp may be a distracter

A moving ceiling fan may be a distracter

Sudden movements in the peripheral field should be restricted

Work surface should be free of visual clutter, especially bright, shiny objects.

Student may need to move closer to visual targets to reduce environmental competing input as well as auditory and/or tactual distractions.
Near/Middle/Distance Viewing - Level 2
Typically, a student who is beginning to use their vision for more functional purposes often begins to extend their visual attention beyond near space and up to 4 to 6 feet. They are also starting to move or become mobile. By using a favored visual object, such as a red mylar pom pom, and placing it just out of reach, the child is encouraged to reach and move forward to retrieve it.

Continue to allow student to get as close to target as needed; this reduces visual complexity.

Continue presenting visual targets in student's preferred visual field.

Use of a slant board, reading stand, tri-fold black felt covered board, or All-In-

One Board is helpful in bringing target into visual field (black painted clothes pins with Velcro work well on felt covered slant boards, to hold visual targets in place).

Allow child to avoid visual gaze, if necessary: may turn head away from target when reaching for it or may observe the target by looking off to one side of the target (eccentric viewing).

Continue to use targets with movement to encourage more distance viewing.

Use visual targets with some favored characteristic; if the child favors red mylar, use red reflective material on targets presented at 4 to 6 feet or outline distant targets with preferred color (red reflective ribbon outlining learning material on a black slant board).

Use SpotLIGHTing Techniques to highlight a target at 4 to 6 feet (see the book, Strategy to See).

Work surface should be free of visual clutter (no stick on alphabet strips, name stickers, notebooks, pens, cell phones, etc.).

Use a brightly colored rug or other symbol to highlight a landmark, then gradually withdraw the symbol and just use the landmark.

Use a florescent orange traffic safety cone, with a bright light inside and a red light on top, to mark the next location the mobile student needs to get to; for example, if the student is at Circle Time but the next activity is at the Fine Motor table, use the lighted orange cone to designate where the student is to travel to next.
Visual Target - Level 2
Since students who benefit from Level 2 Strategies are generally just starting to use their vision for functional purposes, taking a close look at eating and grooming routines will be important. Since eating is such a motivating activity, eating utensils, foods, cups, and plates all need to be made "CVI Friendly", so that the student uses his vision to locate and grasp the items.

Use cutlery that is either a single, bright color or cutlery that lights up. At the website, www.flashingblinkylights, there are some of these items or you can modify a Munchkin Easy Squeezy Spoon to hold a small flashlight.

Create a "Koozie" made out of red (or any other bright color) mylar-like fabric, and place it around an infant bottle. This can be SpotLIGHTed with a high powered flashlight if needed.

Create a "Koozie" made out of red (or any other bright color) mylar-like fabric, and place it around snack containers, such as Gerber Graduates Puffs, and encourage reaching/grasping behavior.

Use glittery, sequined stretchy headbands to wrap around cups or any other item, to create a reflective band that can be SpotLIGHTed.

Use toothbrushes that have a blinking light feature, such as the yellow Firefly Light-up Timer Toothbrush ( www.firefly.us.com). Remember to clear the clutter in the bathroom, leaving only the blinking toothbrush presented against a contrasting color, to encourage reaching and grasping behavior.

Use brightly colored bowls and plates presented against a black or contrasting colored placemat.

Use a lighted red or brightly colored cup (Walgrens; seasonal item) or use a blinking, lighted tumbler, available at www.flashingblinkylights.com.

Choose combs and brushes in a bright, solid color and present them against a black towel or contrasting color. Remember to clear the clutter in the bathroom!

Use single colored recording switches for communication ("yes/no" and "more"). Use only one or no more than two at a time, with good spacing between the two.

Use common objects in a bright, preferred color (or possibly 2 or 3 colors).

Use reflective/shiny material applied to common objects used daily, to help direct visual attention (red, reflective Contac paper, reflective red wide ribbon, yellow glittery paper, yellow/gold reflective gift bag, etc.).

Use of Anticipation Calendar with familiar objects (see: http://www.tsbvi.edu/Outreach/seehear/archive/LetMeCheckMyCalendar.htm

Spacing of visual targets will be important, when more than one target is used (see Spatial Window of Visual Attention or Visual Array). Limit number of targets presented (one or two at a time is best).

Use of Routines and keeping information simple, constant and predictable will continue to be important. For more on Activity Routines go to www.tsbvi.edu and search for, "Getting Started with Activity Routines".

Providing good color contrast will continue to be important. Use a solid colored background and continue to avoid backgrounds with patterns.

Primary books that have reflective qualities are often attractive to students who benefit from Level 2 Strategies.

Students who benefit from Level 2 strategies may still have difficulty with identification of pictures and understanding that pictures represent something. Students at this stage may start to make a transition from identifying their favored 3 dimensional toys/objects to identifying a color photograph of that same favored toy/object. Presenting the color photo on an iPad works well because of the backlighting provided by the iPad.

Teacher/parent made books with color photographs of the students favorite items work well for this stage.

When pictures are used, they should be simple, familiar and only one to a page.

Use color to highlight specific aspects and salient features of objects, shapes and print.
Spatial Window of Visual Attention or Visual Array - Level 2
Students who benefit from Level 2 Strategies can often view 2, 3 or 4 well-spaced visual targets, especially if they are presented in the student's best field of view and against a high contrast background.
Contrast - Level 2
Students using Level 2 Strategies still require good color contrast when working with new to them targets or beginning new routines or lessons. With familiar or favored visual targets, they generally can tolerate less contrast. For example, if a student is very familiar with a lighted yellow ball, the ball might be placed on a golden colored carpet (within 3 to 4 feet) and the student would most likely still visually locate it.

Choose iPad apps that offer slow moving targets that stand out from their background. A good example of an app, which might be used with students who benefit from Level 2 Strategies, would be Tap-N-See Now.
Preferred Visual Field - Level 2
As students become more mobile, use of red duct tape may help to outline doorways, mark the path in corridors as well as highlight steps.

Use reflective strips to make stairs stand out.

Use an Invisiboard (from APH which has a Velcro compatible surface), to affix targets to in the student's preferred visual field. Using a piece of dowel (spray painted black), you can affix Velcro on either end and extend it across a "U" shaped set up of the Invisiboard, so that targets can be hung from the dowel into the student's field of view.
Lighting - Level 2
Lighting continues to be an important factor to initiate looking behavior and to focus attention on the target of interest for the student who benefits from Level 2 Strategies.

Present visual targets on a Light Box (from APH). Some Light Boxes can be slanted to bring targets better into the visual field. You can also download a light box app for a tablet or iPad. Brightly colored window gel stickers work well on the Light Box or app on a tablet.

To encourage mobility, use a lighted orange safety cone. Use the type that have both a blinking red light on the top and have a light inside. Move this cone to various locations around the room and turn on the light when it is time to move to the next location.

Use of a 100 LED flashlight (or flashlight with at least 250 lumens) or supplementary desk light shining on visual targets will continue to be important.

Eliminate glare on all surfaces (do not laminate high-use targets such as Window Markers!).

Dim overhead lights to emphasize lighted visual target; this also has the added benefit of seeming to reduce environmental clutter and complexity.
Familiarity - Level 2
Once teachers and others working with the student know of their favored visual targets, they can then take some quality of the favored visual target and "attach" it to a "new-to-the-student" visual target. For example, if one of the student's favored, familiar visual targets is a red, mylar pom pom, one could take a wide strip of red mylar ribbon and wrap it around a sip-n-seal cup to encourage the student to find the cup and grasp it, just as he/she did with the pom pom.

Continue to use objects and toys in student's preferred color and preferred visual field.
Level 3 CVI Strategies
General Considerations - Level 3

Students who benefit from Strategies at Level 3 often demonstrate more typical visual behavior, but may continue to have difficulty with competing environmental and sensory input while trying to use vision, especially when viewing targets at distance. They may continue to have visual field preferences and often have difficulty viewing targets when presented in their lower visual field.

Students who benefit from Level 3 Strategies often continue to have difficulty with crowding, or the presentation of too many targets in their viewing array, particularly when viewing distance targets. Having a solid contrasting color in the viewing array is often helpful to the student trying to differentiate between background and foreground visual information. Lighting continues to be important, especially for mobility purposes.

Students using Strategies at Level 3 will be responding to more varied visual targets and have greater visual demands. Be careful to watch for visual fatigue and allow plenty of response time, to look at the visual target then respond to it.

Additional response time will especially be needed if the student is tired, stressed, ill, or has just had a seizure.

Be specific about what you want the student to look at.

Good communications between the school personnel and caretakers/parents at home will be crucial.

Use descriptive words and continue to discuss salient features of the visual target.

Continue to monitor pictures for "visual clutter" and use pictures that the student can identify.

When a student benefits from strategies at Level 3, it will be important for all teachers, paraprofessionals and caretakers to follow the same teaching procedures, both at school and at home. For example, if a yellow highlighter is used at school to mark where the student puts the answer on the answer line, these same techniques should be used at home.
Environmental and Sensory Input - Level 3
A student who benefits from Level 3 strategies generally has more typical visual behaviors, but may continue to have difficulty with multiple sensory input, especially with competing auditory input. Parents, caretakers and teachers will need to watch carefully to determine how much competing sensory input the child is able to tolerate while still demonstrating efficient visual responses.

Visual complexity and crowding will most likely still be a concern especially if the student is in a Resource Room or classroom setting and using distance viewing to access information on a dry erase board or when mobile.

Student continues to benefit from increased lighting on both near materials and in the general environment (hallways and stairwells).

Student may still have difficulty with additional auditory and/or tactual distractions; limit these as able.

When mobile in a busy, cluttered environment, it may be helpful to follow a line on the floor or hallway wall made with red duct tape or to follow the line of lights on the ceiling.

When in PE, teammates may need to verbalize where the ball is.

Use of yellow or amber/orange-tinted sunglasses help to make outdoor objects stand out.
Near/Middle/Distance Viewing - Level 3
A student who benefits from Level 3 Strategies may continue to have difficulty with distance viewing and strategies are often needed when visual learning is taking place. Often, the student who is visually functioning at this level, will be in a general education classroom setting, Resource Room, and/or Life Skills Classroom where there is often distance learning, particularly at the white board and/or smart board. When students are in a classroom setting and having difficulty seeing print targets on the dry erase board, use a yellow acetate GlaReducer (from APH) outlined in red duct tape, then place it over the print of interest on the dry erase board. Alternately, use magnetic strips covered in red mylar wide ribbon to create a box around important information on the board.

Distant targets (10-15 feet) will need to stand out in some way, especially when there is "visual clutter" surrounding the target of interest.

Use Color - A teacher wearing a lighted red hat is easy to locate in a busy cafeteria or a classmate is easier to find on a busy playground when he/she is in a bright, red shirt

Use Light - A high-powered flashlight shining on hands as they sign an assignment makes them easier to see for the student who has hearing difficulties in addition to CVI

Use Movement - a waving flag at the top of a flagpole is easier to locate than a limp, still flag hanging drooping along side a flagpole

Bright, florescent colors will still draw student's attention.

Student may need to get up and get closer to materials and targets to reduce crowding and other visual distracters.

Work surface should be free of visual clutter (no stick on alphabet strips, name stickers, notebooks, pens, cell phones, etc.).

When using a Smart Board and Power Point Presentation from the computer, use the movement of the cursor (displayed on the Smart Board) to attract visual attention - it causes a jumpy movement that is easy to spot at distance.

Use color to draw attention to landmarks. For example, outline a water fountain with red mylar wrapping paper to signal where to turn in a hallway or outline the classroom door in red duct tape or red rope lights to indicate the correct location.

Use black "frames" to attract attention to distance targets (use precut, black mat board frames from craft store; they come in various sizes). You can outline these in red mylar "garland".

When encouraging a student to look for a target in the distance, use a verbal prompt and a large visual target to "cue" the student to the chosen target ("Look at the big green tree then the brown building" or "Look where my hand is pointing on white board").

A student's table or desk will stand out at distance by attaching a yellow "ink blotter" on the workspace; keep the "blotter" in place with clear Contact Paper.

A student's chair will stand out at distance by using a different color of chair from the other students or by attaching a brightly colored pom pom on the seat back.

Distant PE equipment that is brightly colored and has movement qualities will be easier to locate and see (i.e. swinging bright blue swing or a fluorescent colored ball or birdie).

Use the camera function on tablets to take pictures of distance targets and then let the student use the zoom feature to look at picture details.

Students who use an iPad will benefit from the camera function, taking a picture of distance targets, such as the notes on a dry erase board, then use the zoom function to look closely at small details.

Students in a classroom or Resource Room setting might benefit from use of a CCTV for distance viewing. The two I have found that work best for our students are the CCTVs that have a camera that can rotate and move to where the teacher is or to the specific board of interest. These include the SmartView 360 (www.humanware.com) and the Acrobat (www.enhancedvision.com).
Visual Target - Level 3
Students who benefit from Level 3 strategies will still need books, worksheets, pictures and other two dimensional materials to be modified.

Students may be starting to identify more pictures including color photographs, and simple, black line drawings.

Eliminate details that are not important to the page. Use correction fluid to eliminate all page numbers or non-important visual clutter, eliminate all but the outer black outline of pictures, etc.

When looking at multiple shapes, numbers or letters, encourage the student to track with his/her finger; point to each symbol and slide the finger from target to target.

Use color;

Outline letters or numbers with a red permanent marker

Highlight aspects and salient features of shapes, objects, and print with a colorful highlighter

Highlight the answer line on worksheets (be consistent in the use of one color on all answer lines/worksheets)

Highlight target or word with a yellow overlay or yellow transparency

Pastel colored pictures should be re-colored with bright primary colors

Brightly colored shoe laces; one color for the left shoe and one color for the right shoe

Specific colored tote boxes for specific items; blank paper in one colored tote and completed assignments in another colored tote

Clearly mark the beginning and end of a line of print with marker or highlighter (use green marker outlining first letter in line - red marker outlining last letter in line; use highlighter reusable tape; use colored stick-on dots by Dennison, etc.)

Use colorful/reflective Contac Paper to stick on and outline targets of interest

Simplify visual targets to help reduce the "crowding phenomenon";

Use window markers to emphasize visual target of interest (cut a "window" in black construction paper to outline target of interest)

Use Bright Line Markers (from APH) and/or black paper markers

Use correctional fluid to eliminate non-essential details that are distracting and contribute to visual clutter

Cut or fold worksheets/papers to allow only small parts to show at a time - reduce the amount of information presented

Student may benefit from modifications in PE equipment including brightly colored balls, beanbags, and birdies, brightly colored bases for baseball and teammates who all wear the same brightly colored tee shirts, making them easier to locate on the field.

Students in a classroom or Resource Room setting often benefit from use of a CCTV for near viewing. As noted above, the two I have found that work best for our students include the SmartView 360 (www.humanware.com) and the Acrobat ( www.enhancedvision.com). These CCTVs allow the student to enlarge the near target and to adjust the background color to suit their needs.
Spatial Window of Visual Attention or Visual Array - Level 3
The spacing of visual targets in the visual array may continue to be important; teachers, caretakers and parents may still need to reduce crowding and complexity as students are able to view greater numbers of targets.

Special attention will need to be paid to any augmentative and alternative communication (AAC) aid and/or device that the student might be using. Many commercially made aids and devices have spaces for 9 to 20 small pictures. Even for a student who benefits from Level 3 Strategies, this array is too busy and cluttered. In addition, the pictures most often used with these devices are inappropriate (see information on pictures under Targets). A more appropriate AAC device might be a teacher made aid or a voice output device that only has 2 or 3 windows. Alternately, black paper can be placed in windows and only a few window choices can be offered, which will create a less busy array (see "Talk Bar" from Learning Resources).

If the student is starting to read, it will be important to use a program with large spaces between words and pictures; The Primary Phonics (K-2) series is an example.

Use books with one clear, simple picture on a contrasting simple background.

Develop custom worksheets and provide good spacing between words and between sentences (easy to do on the computer).

Limit the number of words/sentences on a sheet.

Create more white space by using correction fluid, folding the paper to hide "visual clutter", enlarge the paper, and use blocking techniques. For example, use a black piece of heavy tag board and block off non-necessary visual details.

Encourage the student to keep items on the desk to a minimum; emphasize organization.

Encourage the student to keep books and materials organized in color-coded folder inside of the desk. A battery operated light, attached inside the book storage part of the desk, will help the student locate needed school supplies more easily and quickly.
Contrast - Level 3
Students who benefit from Level 3 Strategies generally can tolerate more complexity surrounding the target of interest at near, but often continue to have difficulty with targets at distance. They still need for the distance targets to stand out in some way with either color, movement, light or with an auditory cue.

Students using Level 3 strategies who use a CCTV will benefit from the models that allow a choice of background contrasting color.

Students often benefit from PowerPoint presentations when the target on the screen is a bright color and the template used is a darker color.

When creating student specific books on a tablet, use apps, which offer a variety of background colors and text colors. A good example of an app to use might be Book Creator.
Preferred Visual Field - Level 3
Present targets in student's best visual field;

Allow student to move materials where they can see them most efficiently

Allow student to move their body to where they can see the materials most efficiently

Determine if student views materials more efficiently in horizontal plane or vertical plane

Use a slant board or reading stand

Allow student to tilt or turn his/her head to the best angle for viewing targets and reading.

Students using tablet technology can bring the tablet up into their preferred field of view by using a stand similar to the Tablet Combo Stand by RJ Cooper.

When mobile (either walking or in a wheelchair), the student may need to turn his/her head all the way downward, due to low visual field difficulties.

Position student so he/she is better able to use preferred visual field (if they are better able to use their far right visual field, they should be sitting towards the left side of the classroom).

When mobile and using stairs, watch for lower visual field difficulties; mark stairs with red duct tape or red reflective tape.

When mobile, travel in brightly lit hallways and stairwells.

Work on use of a, "slow, look, check, and go" method combined with verbal prompts, or a tap on the shoulder, when there is uneven ground and/or there is a concern with lower visual field.
Lighting - Level 3
For students in Resource Room settings or general education classroom settings, it is helpful to attach a small battery powered light inside of the book section of the desk, to help the student locate needed books and supplies.

Working in a well-lit environment will continue to be beneficial.

Watch for shadows as student bends over work; seat the student under overhead lights so that shadows are not cast on their near work.

Use of a small, battery-powered desk light is helpful for students moving from class to class (when they need additional supplementary lighting on their materials).

Use a PowerPoint Presentation to teach concepts; dim overhead lights, use programs that have movement, use a cursor that provides movement qualities.

Eliminate glare on computer monitors and workspace.

Seat students who benefit from increased illumination near a wall outlet (to plug in a desk light), when possible.
Familiarity - Level 3
Usually, by the time the student is working with Level 3 Strategies, he/she has little (or at least less) difficulty with Familiarity.

Created by Diane Sheline, TVI, CLVT

diane@strategytosee.com

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Strategies for Students with Cortical Visual Impairment (the handout)

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Strategy to See Strategies for Students with Cortical Visual Impairment (the handout) Formally titled, "Encouraging Efficient Use of Vision in Students with CVI" The following are suggestions to use with infants, young children, and students who have Cortical Visual Impairment (CVI) or who are suspected to have some other form of brain damage related vision...

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Learn about the 3 Phases of CVI as defined by Dr. Christine Roman-Lanzy

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Learn about the 10 characteristics of of CVI as described by Dr. Christine Roman-Lanzy

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Whether you're the parent of a child with CVI or a teacher of students with multiple disabilities, our free video presentations offer useful tips and techniques:

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What is the purpose of this tool? The aim of this tool is to provide those working with a child with visual impairment due to damage to the brain (cerebral visual impairment or CVI), with a range of ideas and strategies to help. These have been suggested over the years by many parents of children with CVI.

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Cortical Visual Impairment: Special Topics

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Office of Special Projects - Blind and Low-Vision Services

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Christine Roman-Lantzy, Ph.D. is the Director of the Pediatric VIEW (Vision Information and Evaluation at West Penn Hospital) Program in Pittsburgh, and a private consultant for CVI Resources. A teacher of visually impaired students, certified orientation and mobility specialist, and infant developmentalist, Dr. Roman-Lantzy is also a CVI project leader for the American Printing House for the Blind.

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Welcome to Diane Sheline's website! Please explore all the pages and information using the navigation bar and pull down windows.

Contact Information:

Diane Sheline
strategytosee@gmail.com

NEWS:

The 4th Edition of Diane's book, Strategy to See: Strategies for Students with Cerebral/Cortical Visual Impairment, is available to the public at Amazon, or through this link*.
https://amzn.to/2ll7imr
Note: As an Amazon Associate I earn from qualifying purchases.

Presentations; Diane offers a wide variety of presentations for teachers of students with visual impairment, Orientation and Mobility Instructors, therapists, general education classroom teachers and parents in the area of Cerebral/Cortical Visual Impairment.

Upcoming Trainings and Presentations:

February 24, 2020, Perth, Australia (Independent Living Center, WA)

March 19, 2020, DC-MD AER Annual Conference in Annapolis, Maryland

March 26, 2020, Nebraska City, Nebraska (CVI Literacy Workshop and Make and Take)

March 31, 2020, Charlottesville, Virginia (Virginia AER at Doubletree by Hilton)

April 2, 2020, San Marcus, Texas (Texas AER at Embassy Suites; Literacy Make and Take)

April 25, 2020, Texas Tech. University

May 11, 2020, Ask the Expert Series Webinar, sponsored by Maryland School for the Blind

Early September, Tentative, Alabama Institute for Deaf and Blind

October 27, 2020, Tentative, Baton Rouge, Louisiana, Louisiana School for the Visually Impaired

December 16 and 17, 2020, Region 4 Educational Service Center, Houston, Texas

Recent comments from teachers and others who attend my presentations;

"Excellent presentation mixing neuro background with terms used with CVI and then actual, very practical strategies."

"Diane was an excellent presenter. As a parent of a kid with CVI, I learned so much."

"I appreciate the wealth of information presented and how relevant it is to my practice. Great presentation."

"So much great info - personal stories make connections."

"Lots of great information. Down to earth and helpful. Items that I can make and use!"

"Speaker is VERY knowledgeable and the examples/materials presented are very practical!"

"Excellent actual objects that are used with different Phases."

Recent comment from a parent, after the assessment of her son;

It was a pleasure to meet you in person. I want to thank you for testing my son and for all the "tips and tricks!" that I learned. The trip to Houston was worth every mile. It's going to be a long process and a lot of work but we have to try to do our best. Thanks again!

CVI Den: To make my CVI Den, the easiest, most inexpensive device to use is the Glow Crazy Doodle Dome. I have recently heard from many people who visit my website regarding the difficulty in locating the Doodle Dome. It is no longer available through Amazon! It is however, available through stuffedanimals.com at a relatively reasonable cost;

If this Doodle Dome has any "white board area" inside of the tent (there are different models out there), then you will need to use fabric glue and cover them with black fabric. I recommend using a Velcro compatible fabric, like headliner material, so that you can affix objects to the side if needed.

Alternately, you can purchase a deluxe model called a Personal Pop Tent found at;

Learn more about making and use of a CVI Den for students just beginning to use their vision and even students who are high Phase 1 or beginning Phase II in the DIY section of this website.

CAD (Complexity at Distance) Screening Device is now for sale- used to observe if students have difficulty locating specific targets, at 10 feet, when presented on a typical Grade 2 or Grade 3 white board: http://www.teacherspayteachers.com/Product/CAD-Complexity-at-Distance (see tab for more details)

In addition to information on my website, there is more information on literacy strategies at: http://www.perkins.org/resources/webinars/ and click on the Webinar titled, "Strategies For Improving Literacy Skills In Students with CVI"

Or, go to the Paths to Literacy website, to learn more strategies on literature. The following are links to these publications;
http://www.pathstoliteracy.org/topic/cvi/overview http://www.pathstoliteracy.org/topic/cvi/literacy-children-cvi-guidelines-modifying-books-students-phases-i-ii-and-iii http://www.pathstoliteracy.org/topic/cvi/adapting-books-and-literacy-students-cvi http://www.pathstoliteracy.org/topic/cvi/general-materials-used-adapt-books-children-cvi http://www.pathstoliteracy.org/strategies/where-red-gift-bag http://www.pathstoliteracy.org/strategies/three-bright-red-pom-poms-lined-row http://www.pathstoliteracy.org/strategies/three-silver-pie-tins-and-one-red-puff http://www.pathstoliteracy.org/strategies/one-yellow-slinky-bouncing-and-down http://www.pathstoliteracy.org/strategies/five-little-lights http://www.pathstoliteracy.org/strategies/getting-ready-school-cvi-friendly-pegboard-book http://www.pathstoliteracy.org/strategies/cliffords-family-modified-version http://www.pathstoliteracy.org/strategies/my-favorite-things
More information on general strategies can be found at;
http://www.tsbvi.edu/cvi-exercise/cviintervention
Bubble Words (C. Roman-Lantzy): Create your own "Bubble" words at;
http://roman-word-bubbling.appspot.com/
News Alert: There is a very small chance that certain models of the iPad (iPad 2) may be harmful to students with programmable shunts, particularly when the child gets VERY close to the iPad. Please learn more about this if your child/student has a programmable shunt and you are using an iPad with them. For more information please see;

The YouTube video titled, Apple iPad 2 and Shunts, by Gillette Children's Specialty Healthcare
http://www.montanadrive.mt.gov/groups/ipad/weblog/c0df5/iPad_2_and_Programmable_Shunts.html
* Note: Strategy to See is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites.

Disclaimer: Many of the products mentioned on this website are visually enticing and used to encourage more consistent looking behavior; they are not intended to be used as toys nor are they all entirely child safe. Children should be monitored at all times and products used are used at your own risk.

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Welcome to Diane Sheline's website! Please explore all the pages and information using the navigation bar and pull down windows. Contact Information: Diane Sheline strategytosee@gmail.com NEWS: The 4th Edition of Diane's book, Strategy to See: Strategies for Students with Cerebral/Cortical Visual Impairment, is available to the public at Amazon, or through this link*.

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Anyone who has spent time researching CVI knows that there are a variety of names and definitions for this neurological visual impairment. The fact that it is caused by an incident to the brain complicates the search for one definition because there is much that we still do not know about the brain. There is a need to organize what we currently understand about CVI leaving room for new information as it is researched and made available. There are strategies, products, assessments and resources that are appropriate for some CVI students, but not for others. Establishing a classification system would allow teachers and parents to understand more easily what materials they should be looking at to help in the education of their student. Dr. Lea Hyvarinen and August Colenbrander write about the need for an international classification in their chapters of the book edited by Gordon Dutton and Martin Bax titled "Visual Impairment in children due to damage to the brain."

Those working with children diagnosed (and many who remain undiagnosed) with CVI understand that the more we learn about this neurological visual impairment the more complicated the conversation becomes.

In 2007 when AFB Press released "Cortical Visual Impairment: An Approach to Assessment and Intervention" written by Christine Roman-Lantzy our field has been able to use the CVI Range to assess student functioning levels, monitor progress on the CVI Resolution Chart and provide recommendations and interventions for the team working with the child. The book has become an invaluable resource for educators and families working with this population. But, there are learners that may not be identified by this assessment alone. Dr. Gordon Dutton writes "The severity of CVI can range widely between profound and disorders of visual perception only. The subject is complex, but it is important for the educational assessment team to address the issue fully when assessing an affected child and planning management" (Dutton, 2013). Those students presenting disorders of visual perception, often go undiagnosed because their needs may be hidden. These children may be academic, traveling independently, but facing many challenges for which accommodations are necessary.

Dutton and Lueck (2015) offer a description of three groups of children in their AFB book "Vision and the Brain: Understanding Cerebral Visual Impairment in Children."

1. Children with profound visual impairment due to CVI, many of whom have additional disabilities

2. Children who have CVI who have functionally useful vision and cognitive challenges,

3. Children with CVI who have functionally useful vision and who work at or near the expected academic level for their age group.

Roman-Lantzy, C. (2007). Cortical visual impairment: An approach to assessment and intervention. New York, NY: AFB Press.

Dutton, G. N. (2013). Types of impaired vision in children related to damage to the brain, and approaches towards their management. Journal of the South Pacific Educators in Vision Impairment, 6(1), 14-30.

Dutton, G., & Bax, M. (Eds.). (2010). Visual Impairment in children due to damage to the brain: Clinics in developmental medicine. London, England: Mac Keith Press.

"We should be cautious not to assume that all children with CVI exhibit the same behaviors. The diagnosis means different things for different children; the effects depend on factors such as how extensive and severe were the insults to the brain, the developmental period during which the insult occurred, the child's previous experience, the presence or absence of additional disabilities, medications being taken, and the child's motivation. Some individuals with CVI have no observable visual responses: others have occasional responses to stimuli, whereas still others have a significant amount of usable vision."
Morse, M. T. (1999) Cortical visual impairment: Some words of caution. RE:VIEW, 31(1), 21-26.

"Vision impairment due to damage to the brain is common in children. Those affected can be identified and managed well by being alert to the possibility that it may be present, and carefully taking a history and assessing all in whom it is suspected."
Dutton, G. N. (2013). Types of impaired vision in children related to damage to the brain, and approaches towards their management. Journal of the South Pacific Educators in Vision Impairment, 6(1), 14-30.

The body of current medical literature concerning conditions associated with a diagnosis of CVI is most likely incomplete. Medical investigators are just beginning to gather consistent data regarding the causes and conditions associated with CVI. It is important to note that not all researchers agree on the full range of causes, the prognosis or even the proper diagnostic label used to describe vision loss due to brain damage. What is needed is more cooperation and dialogue between members of medical and educational disciplines, and specifically among ophthalmologists, neonatologists, neurologists, and other pediatric specialists, in the hope that timely identification will facilitate appropriate referral to specialists who can undertake early intervention."
Roman-Lantzy, C. (2007). Cortical visual impairment: An approach to assessment and intervention. New York, NY: AFB Press.

"It is important to note that many earlier concepts about brain functions were incorrect, which is not surprising because of the extreme complexity of the central nervous system. However, several conclusions can be drawn from recent advances that would benefit professionals who are providing a variety of services to children and adults with visual disorders. Connectivity studies have clearly proved that vision is more complex than was previously thought, and it is not isolated from the other senses but works in close liaison with them. The brain is plastic at any age, but remarkably so during the early years of life. Therefore, exposure to meaningful experiences and age-dependent activities will not only strengthen the visual networks, but will modify the other senses in compensation for the loss of vision."
Jan, J. E., Heaven, R. K. B., Matsuba, C., Langley, M. B., Roman-Lantzy, C., & Anthony, T. L. (2013). Windows into the visual Brain: New discoveries about the visual system, its functions, and implications for practitioners. Journal of Visual Impairment & Blindness, 107(4), 251-261.

"These parents reported that the primary reason they had difficulty obtaining an appropriate education for their children was physicians' and teachers' lack of understanding, knowledge, and training with regard to CVI."
Jackel, B., Hartmann, E., & Wilson, M. (2010). A survey of parents of children with cortical or cerebral visual impairment. Journal of Visual Impairment and Blindness, 104(10), 613-623.

"The brain is intricate in its design and function. Neuroscientists and neuropsychologists are revamping concepts and principles that are related to brain function and vision as more information is obtained and understood. The changes that are emerging from brain research are altering our understanding of cortical or cerebral visual impairment (CVI) in children. In addition, injury to the brain can result in functional manifestations that are complex and multifaceted. These functional manifestations are related to the extent, location, and time of onset of the brain lesions, but the precise effects of these injuries cannot be readily and fully predicted in children from the brain lesions themselves. For example, we have no idea of the ways in which areas of the brain that are intact in young children who have brain damage assume the functions of damaged areas owing to the plasticity of the brain. Thus, an understanding of recovery mechanisms for CVI in children and of the effects of intervention is in its infancy. As a result, our understanding of the nature of CVI in children must be open and flexible as we incorporate and learn to apply an ever-evolving knowledge base. We must understand the issues surrounding CVI, embrace their complexity and lack of closure, and determine directions for the effective diagnosis and treatment of children with CVI from medical and educational perspectives."
Lueck, A.H. (2010). Comment: Cortical or cerebral visual impairment in children: A brief overview. Journal of Visual Impairment and Blindness, 104(10), 585-592.

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Anyone who has spent time researching CVI knows that there are a variety of names and definitions for this neurological visual impairment. The fact that it is caused by an incident to the brain complicates the search for one definition because there is much that we still do not know about the brain.

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"christine roman" cvi "cortical visual impairment" characteristics

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Dr. Christine Roman speaks on CVI, Cortical Visual Impairment. https://www.cviresources.com https://www.facebook.com/ChristineRomanPhD Roman Word Bubbling si...

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CVI Scotland. 819 likes. CVI Scotland aims to offer readers with information about the visual difficulties associated with cerebral visual impairment.

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Or, CVI IS the leading cause of childhood visual impairment:
"CVI has become a leading cause of visual impairment in children in developed countries, as well as in lower and middle income nations, making it a growing global health concern. In a national registry that collected data on 2,155 children with visual impairment in the U.S., from birth to age 3, #CVI was the most prevalent diagnosis (24%), followed by retinopathy of prematurity (ROP) (16%) and optic nerve hypoplasia... (10%). In countries with national healthcare systems that more widely track causes of visual impairment, such as the United Kingdom, CVI accounts for up to 48% of cases of severe childhood visual impairment and blindness. CVI accounted for 27% of such cases in the Netherlands."

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Or, CVI IS the leading cause of childhood visual impairment: "CVI has become a leading cause of visual impairment in children in developed countries, as well as in lower and middle income nations, making it a growing global health concern.

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To further your understanding of cortical visual impairment (CVI), neuroplasticity, and the visual brain. These podcasts and talks can help. So kick back, plug in, and listen.

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Summer is the perfect time to further your understanding of cortical visual impairment (CVI), neuroplasticity, and the visual brain. These podcasts and talks can help. So kick back, plug in, and listen.

Blind On Blind podcast: CVI Teacher Ellen Mazel discusses cortical visual impairment (CVI) on Perkins' Possibility Radio podcast, Blind On Blind. "I went back to my students and the techniques worked and I looked like a genius," Ellen, after attending her first lecture on CVI by Christine Roman-Lantzy, back in the day. Includes her descriptions of the ten characteristics of CVI.

Blind On Blind podcast: Dr Lotfi Merabet of CVI Neuroplasticity Research Group discusses the visual brain and cortical visual impairment (CVI). "The profile of visual impairment is changing." As the only researcher studying cortical visual impairment, Dr Merabet frames CVI as "a public health crisis."

Blindness Is Just Another Way of Seeing: TED Talk by Dr Lotfi Merabet. Blindness has nothing to do with living in the dark. Behind eyes that don't see is a brain that does see. In fact, blind people use the same visual centers of the brain that sighted people do, and can teach us more about the brain than we think.

Can We Create New Senses for Humans? TED Talk by David Eagleman, author of The Brain, The Story of You (highly recommended read for understanding how utterly unique the brain is and how every experience we have shapes the brain and who we are). His discussion of his latest research exploring technology that bypasses sensory impairment will blow your mind.

CVI for the TVI & Other Professionals: Monthly series from Perkins School for the Blind featuring guest speakers on CVI. Some are best viewed but listening is good too. Link includes the fill series.

: Pawan Sinha details his groundbreaking research into how the brain's visual system develops. Sinha and his team provide free vision-restoring treatment through Project Prakash to children born blind, and then study how their brains learn to interpret visual data. The work offers insights into neuroscience, engineering and even autism. And even CVI.

Invisibilia, Batman: This debut podcast episode, Batman, explores the question, Can other people's expectations of you alter what you can do physically? Specifically, they look into something that sounds impossible: if people's expectations can change whether a blind man can see.

Kaleidoscope: The Cortical Visual Impairment Podcast: Sharing stories of neuroplasticity and visual perception. A podcast by Jessica Marquardt, CVI parent. You do not want to miss this podcast on the parent experience of navigating through diagnosis and the medical and educational worlds with a child who has CVI.

What Do Hallucinations Reveal About Our Minds? TED Talk by neurologist and author Oliver Sacks on Charles Bonnet syndrome - in which visually impaired people experience lucid hallucinations. He describes the experiences of his patients in heartwarming detail, and walks us through the biology of this underreported phenomenon. "We see with the eyes, but we see with the brain as well."

Increasing awareness of Cortical Visual Impairment (CVI). CVI is the leading cause of visual impairment in children. View all posts by StartSeeingCVI

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Summer is the perfect time to further your understanding of cortical visual impairment (CVI), neuroplasticity, and the visual brain. These podcasts and talks can help. So kick back, plug in, and listen. Blind On Blind podcast: CVI Teacher Ellen Mazel discusses cortical visual impairment (CVI) on Perkins' Possibility Radio podcast, Blind On Blind.

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Perkins School for the Blind and Perkins eLearning bring you Perkins eLearning To Go in the hope that by hearing from leaders in the field of visual impairment you’ll become better equipped

to educate children with vision loss.

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Welcome Listeners!

Perkins School for the Blind and Perkins eLearning bring you this podcast in the hope that by hearing from leaders in the field of visual impairment you'll become better equipped to educate children with vision loss.

Dive in and hear from experts, parents and students!

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Skip to content Skip to section navigation Perkins School for the Blind and Perkins eLearning bring you this podcast in the hope that by hearing from leaders in the field of visual impairment you'll become better equipped to educate children with vision loss. Dive in and hear from experts, parents and students!

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CVI is the leading cause of pediatric visual impairment

in the developed world. But there’s hope. Due to the brain’s neuroplasticity, a child’s vision can improve. Tune in for a monthly discussion on Kaleidoscope.

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Cheyanne Marcy has been an advocate on big stages, on everyday social media platforms and in day-to-day life on behalf of her son, Archer (5). She values action and advocacy - and has navigated not one, not two, but three state education systems.

She writes, "... I learned I was not doing enough to advocate for my...

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Kaleidoscope: The Cortical Visual Impairment Podcast

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Cortical visual impairment (CVI) is the leading cause of pediatric visual impairment in the developed world. The eyes can see, but the brain can't interpret the visual world. Due to neuroplasticity, the functional vision of a child with CVI can improve. The number of children with CVI is growing, so why isn't anyone talking about this public health crisis?

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Teacher Ellen Mazel discusses

CVI on the Blind On Blind podcast