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with Lynne McAlister and Sara Kitchen, Certified Teachers of the Visually Impaired.

Lynne: In the Individual CVI, certain characteristics show up.  These characteristics come from Christine Roman-Lanstzy's research. And, usually, a students will have all of these characteristics.

The ones that we are most familiar with...

Sara: Or to some degree, to some degree.

Lynne: Um, and we're just gonna go in order.

For a complete listing of Strategies and Techniques to use with students with CVI, go to Diane Sheline's web site; www.strategytosee.com   
Or contact Diane Sheline at: 

Phase I

  • Yellow or red beeping ball (from APH, Sound Ball)
  • Red reflective self-adhesive covering (Con-Tact Brand, Red Glimmer)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Black gloves (From APH, Sensory Learning Kit)
  • Red Mylar Pom Pom (www.orientaltrading.com, Toys R Us, Hobby Lobby)
  • Yellow slinky, red slinky (www.orientaltrading.com, Toys R Us)
  • Super-Bright 100 LED Flashlight (www.amazon.com)
  • Invisiboard (from APH)
  • All-In-One Board (from APH)
  • Colorful, single colored targets with Velcro on back
  • Yellow ball, yellow bowl (from APH, TOAD Kit)
  • Children’s pop-up tent lined in Velcro compatible fabric
  • Red bike safety light (Extreme LED Safetylight, SX-6000 Extreme Mini-Pro, www.duravisionpro.com)
  • GE 100 Lights Super Sphere - red
  • Swirly Mat (from APH, in the TOAD Kit or order separately)
  • Gold mylar gift bag
  • Red spoon with mylar ribbon attach to it

Phase I, Clip 1

  • Invisiboard (from APH)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Large red ball (Celebrate It Christmas, Craft Ornament, from Michael’s, seasonal)
  • Red and Yellow slinky (www.orientaltrading.com, Toys R Us)
  • Red pom pom (www.orientaltrading.com, Toys R Us, Hobby Lobby
  • Yellow pom pom (from APH, Sensory Learning Kit))
  • Super-Bright 100 LED Flashlight (www.amazon.com)

Phase II

  • Purple pom pom (www.orientaltrading.com, Toys R Us)
  • Red beeping ball (from APH, Sound Ball)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Reading stand, black (from APH)
  • Mac switch (from APH, Sensory Learning Kit)
  • Power switch (from APH, Sensory Learning Kit)
  • GE 100 Lights Super Sphere - red
  • Lightbox (from APH)
  • Lightbox Materials, blocks and bowls (from APH)
  • Super-Bright 100 LED Flashlight (www.amazon.com)
  • Red Elmo doll (Toys R Us)
  • Red blinking cup (Walgreens, 2 for $5.00, seasonal)

Phase II, Clip 1

  • Invisiboard (from APH)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Flashlight and yellow ball cap (from APH, Sensory Learning Kit)
  • Ott Lite/standing floor light

Phase II, Clip 2

  • Invisiboard (from APH)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Blinking light toothbrush, in red or yellow, made by Crayola (purchase at any drugstore or grocery store in the toothbrush section)

Phase III

  • Yellow highlighter (Office Depot)
  • Yellow Highlighter Tape (Lee Products, ½” Removable Highlighter Tape)
  • Reading stand, black (from APH)
  • Yellow or Red Avery Self-Adhesive Coding dots (Office Depot)
  • Red (or yellow) reflective tape/strip (from hardware stores or www.findtape.com)
  • Black mat/frame (from hobby store or Michael’s)
  • Yellow glare reducer sheet (from APH, GlaReducer Sheets, 4 pack)
  • Black template, or “window”, cut from black construction paper 
  • Bright Line Marker (from APH)
  • Desk light (from APH, Lighting Guide Kit)
  • Red Elmo with red mylar ribbon “tie”
  • Children’s book with reflective, mylar-like pages
  • Large, black mat “frame” cut from black foam board

Phase III, Clip 1

  • All-In-One Board (from APH)
  • Drymate Gas Grill Mat (black, 28”X42” or 30”X58”, www.drymate.com)
  • Red, plastic letters (Toys R Us or Teacher Supply store)
  • Desk light (from APH, Lighting Guide Kit) or Ott Lite

Phase III, Clip 2

  • Black “frame” cut from black foam board

For a complete listing of Strategies and Techniques to use with students with CVI, go to Diane Sheline's web site; www.strategytosee.com   
Or contact Diane at: 

 

with Diane Sheline, Independent Consultant, CTVI, CLVT.
www.strategytosee.com

Sara: I'm pleased to introduce the presenter of the intervention piece of this training. Diane Sheline has been a TVI since 1980 when she received her Master's degree from San Francisco State University in the field of Visual Impairment.  For the past eight years, however, Diane has followed her interest in the area of evaluation and assessment.  She found that she needed a tool to assess the growing number of referrals that were being received.  These students that were being referred had CVI or other brain-related vision loss. She began using Christine Roman-Lantzy's Assessment and with increasing confidence, she has assessed students for the past eight years using this tool. When speaking with TVIs around Texas, I began to hear from them who have been to Diane's training that it was very, very beneficial for them.  They really felt like they got some good solid hands on real-life sorts of ideas that they could use for intervention.  And that is why I hunted her down to get her to help with this training. And luckily for me, she graciously accepted.  So without further ado, here's Diane.

Diane: Hi, I'm Diane Sheline, and I'm happy to be here to share with you some techniques and strategies I have found helpful in encouraging students with brain damage-related vision loss or cortical visual-impairment to use vision more consistently and efficiently.  Before I get in to techniques and strategies, I'd like to discuss two important points. 

One of the most important breakthroughs of modern neuroscience is the discovery of neuroplasticity which is the brain's ability to change and adapt.  A damaged brain can often reorganize itself so that when one part fails, another can often substitute.  Since plasticity seems to be highest when children are young, it's particularly important to figure out what will encourage children to use looking behavior and use their vision efficiently.  Because then, we encourage a positive influence on how the visual system develops and functions.  Exactly what interventions we will use will change overtime as more discoveries are made about how the brain functions and how we can intervene to improve change. 

In a recent PBS program on the topic, they noted seven key factors and I'd like to mention them to you now.  Change can occur only when the brain is in the mood, alert, on the ball, ready for action.  Change strengthens connections between neurons engaged at the same time.  The brain builds on its successes.  Neurons that fire together, wire together.  This helps the brain get better at its predictive capacity.  Associations can be made more easily.  Initial changes are just temporary while the brain can learn through impact which is a powerful experience. Usually, it learns through lots of repetition, doing the same thing again and again and again.  Brain plasticity is a two-way street.  It can change itself in positive or in a negative direction.  Memory is crucial for learning.  Where you put your attention is important.  Practicing something while distracted won't help the brain change.  And the last is motivation is a key factor. 

The second point I'd like to make is that educational strategies which encourage efficient use of vision that I will share with you today may not be the same ones we use in two years or in ten years from now but I've seen a positive change in my student's visual attending behavior by using them and I hope you will, too.  I've been using Dr. Christine Roman-Lantzy's materials for many years now, and I've found that when I evaluate a child with a brain damage-related vision loss or CVI and looks specifically at the CVI-related characteristics as well as determine the degree of each of these characteristics.  I am better able to tailor a program that encourages the child to use their vision efficiently. 

To discuss specific strategies and techniques, I will break them down into strategies most commonly used in Phase 1 students, with Phase 2 students and Phase 3 students.  Viewers should note that each and every student who has CVI has unique abilities, and these strategies that I'm going to present to you today are intended to only give you an idea of what might help encourage looking behavior.

I hope that they spark some great ideas for you.

Case Study, Phase 1: Parent Interview

with Eric Grimmett and Sara Kitchen, Certified Teachers of the Visually Impaired.

Sara: Let's get started with the parent interview.

Eric: Let's.

Sara: Okay.  So the first question, "Tell me what you do with the toy to get your child interested in it?"  Brandon's parents said, "I put the toy in his hand to hold."  The school said, "Shake it, tap it, make noise, introduce it on his lap, put it on the light board and move it."

Eric: All right, this question targets Movement and Fields, and in terms of what the school answered, we had positive for a CVI for Movement.  So, if you're doing this for practice, you mark Row 2, you go down this Resolution Chart and Brandon's basically in the Range 1-2.

Sara: Question Number 2.  "When you show your child something, how do you know he or she sees it?"  Brandon's parent wrote, "Not! Brandon is blind." The school wrote, "Head orientation towards object, "slow reach out towards it.  Usually with light board or art."

Eric: This question targets Visual Attention

and Non-purposeful Gaze, that's Row 6 on your Resolution Chart.  Again, we have the school answering positive for light gazing here and they speak about the light box.  So, if you're practicing, mark this in Row 6, and Brandon, again, is about in Range 1-2.

Sara: Question Number 3.  "Does your child have a favorite side or a favorite head position?"  Parent says, "The right side, also, head position."

The school says, "Left side for viewing, right side for most activity, usually head's slumped."

Eric: Okay, this question is asking about Field Preference, Row 4, and additional disabilities.  The answer is positive for Fields so you mark in Row 4.  Again, Brandon is about Range 1-2 there.

Sara: Question Number 4.  "Does your child usually find objects by looking or by feeling for them?"  Brandon's parents say, "He is blind."  The school says, "He is not usually motivated to look for items, but primarily, he uses touch when he does."

Eric: This question asked about Visually Guided Reach which is Row 10 or Visual Complexity which is Row 5.  And in this case, really, we have to say the answer is inconclusive on both interviews.

Sara: Number 5. "Do you have concerns about the way your child sees?"  The parent says, "No, he is blind."  The school did not answer that.

Eric: Okay, so number 5 is asking about appearance of the eye, the eye exam, and the answer is inconclusive on this one as well.

Sara: Number 6.  "Where do you usually hold objects for your child to look at?"  Brandon's parent say, "I put them in his hand to hold only, he is blind."  The school says, "The center to the left side within a 1-foot range."

Eric: This question asked about Visual Field Preferences, Row 4, and Visual Complexity, Row 5.  Answers are positive for field, center-left, and for distance, within 1 foot.  So you mark in Row 4 fields, Range 1-2.  And in Row 7, the Distance row, Range 1-2 as well.

Sara: Number 7.  "What are your child's favorite things in your house?"  The parent says, "The piano, the radio." The school says, "The radio, shakers, rain sticks, drums, instruments, keyboards."

Eric: Okay, this question targets Light Gazing, Non-purposeful Gaze, Row 6, Movement, 2, and Visual Novelty, Row 9.  Answer is inconclusive for this but we do see that Brandon does really like sound devices and devices that emits some kind of music.

Sara: Question number 8.  "What if anything have doctors told you about your child's eyes?"  Brandon's parent said, "They said he was totally blind but I don't think so."  The school did not answer.

Eric: Okay, this question is focusing on the eye exam again and the parents' answers are very telling.  They've been told that their child is totally blind but their answer is, "But I don't think so." So, positive for CVI there, I'd say.

Sara: Okay.  Number 9.  "When does your child usually like to look at things?"  Parent, "Not! He is blind."  The school says, "In front of the light board, he will look at sounds."

Eric: This question asked about Visual Novelty, Row 9, and Complexity, Row 5.  The answer is positive for Light Gazing, which is in Row 6, and Brandon's in about a Range of 1-2 there.

Sara: Number 10.  "What color are the things your child likes to look at most?"  His parents say, "None, he is blind."  The school says, "He might be a little more attentive to red."

Eric: This question is asking about Color Preference, obviously, which is Row 1, and Novelty, Row 9.  The answer is positive for Color Preference in terms of the school, so you mark in Row 1, Range 1-2 for Brandon.

Sara: Question Number 11, "What does your child do when he or she is near very shiny or mirrored objects?"  Brandon's parents say, "Nothing, he is blind."  The school says, "There's no noticeable change in affect but they do use tin foil on some symbols, but it's also coupled with noise."

Eric: This question is asking about three different areas, Light Gazing, which is Row 6, Movement, Row 2, and Color Preference, Row 1.  However, the answer is inconclusive on both interviews for this question.

Sara: Question Number 12.  "Describe how your child behaves around lamps or ceiling fans."  Brandon's parents say,  "He looks upward to fans and up to light."  School, they didn't notice a change in behavior.

Eric: This question is asking about Non-purposeful Gaze and Light Gazing, Row 6.  The answer is positive, so mark in Row 6, Range 1-2.

Sara: Number 13. "Are you usually able to identify what your child is looking at?"  Brandon's parents say, "Yes."  The school says, "If he is trying to use his vision, he will put his face on the object to see it."

Eric: This question is asking about Non-purposeful Gaze but the answer that we received is positive actually for distance. So you wanna mark that in Row 7, Range 1-2.

Sara: Number 14.  "Does your child usually first notice things that move or things that don't move?"  Brandon's parents say, "Things that move."  The school says that they're undecided.

Eric: This question is asking about Movement, Row two, and Fields, Row 4.  The answer is positive CVI for Movement.  So you mark that in Row 2, Range 1-2.

Sara: Number 15.  "How does your child position his head when you think he is looking at something?"  Brandon's parents said, "He leans to the right to listen to things."  The school says, "No answer."

Eric: Okay, this question targets Fields in Row 4, and the answer is inconclusive because they actually address listening at this point.

Sara: Number 16. "Do you think your child has a 'favorite' color?"  Parents say, "No."  The school says, "Maybe red."

Eric: Okay, again, this question is about Color Preference and the answer is positive.  Mark on Row 1, Range 3-4 this time for Brandon.

Sara: Number 17. "Does your child seem to notice things more at home or in new environments?"  The parent says, "No."  The school didn't answer.

Eric: And this question targets Complexity of Array and Non-purposeful Gaze and Novelty.  And, of course, the answer is it's inconclusive on both interviews here.

Sara: Number 18.  "Describe how your child positions his head when swatting or reaching towards something."  The parent says, "Straight."  The school says, "No regular correlation."

Eric: Okay, this question targets a Visual Motor, Row 10, and Field Preferences, Row 4.  The answer is inconclusive.

Sara: Number 19.  "How does your child react when you give him new things to look at?" Parent says, "He does not, he is blind."  The school says, "He will reach out and touch it."  Eric: Okay, this question targets Novelty, Row 9, and Complexity, Row 5. For the school's sake, answer is positive for Novelty because he does reach for new things. So you mark that in Row 9, under Range 3-4 for Brandon.

Sara: Number 20.  "Do you position your child in a certain way to help him see things?"  The parents said, "No."  The school said, "Items on the left side, light underneath."

Eric: This question asks about Fields and Complexity, Rows 4 and 5.  The answer is positive for Fields, so you mark that in Row 4, Range 1-2.

Sara: Number 21.  "Have you ever been concerned about the way your child's eyes move?"  The parents say, "No," and the school says, "No answer."

Eric: Okay, this question is asking about eyes and it targets those kids who do not already have a CVI diagnosis.  The answer in this case is inconclusive.

Sara: Number 22.  "What does your child do when there are many objects

in front of him to look at?"  His parents says, "He is blind."  The school didn't answer that one.

Eric: Okay, this question targets Complexity, Row 5, and Novelty, Row 9, and the answer is inconclusive.

Sara: Number 23.  "Tell me about the faces your child prefers to look at."

The parent says, "None, he is blind."  Eric: This question targets Novelty, Row 9, and Complexity, Row 5, and the answer again is inconclusive.

Sara: Twenty-four.  "If your child had his own object to look at and a new object, which object would he prefer?"  His parent says, "Remember that he's blind."

Eric: Okay, this question is looking at Novelty, Row 9, and Complexity, Row 5 again, and the answer again here is inconclusive.

Sara: Question number 25.  "Tell me what your child's favorite objects or toys look like."  Brandon's folks say, "He has no favorite objects or toy."

Eric: And again, this question is focusing on Novelty and Complexity, Rows 9 and Row 5.  The answer is inconclusive, and that gives us really a total of 13 positives for CVI, 0 negatives and 12 inconclusives.

Sara: And that's probably enough to think, you know, just to think about CVI might be contributing to Brandon's visual behaviors considering also the red flag of him having a closed head injury.  Don't you think?

Eric: Yes, definitely, definitely.

with Eric Grimmett and Sara Kitchen, Certified Teachers of the Visually Impaired.

Sara: We observed Brandon one time and then we had multiple opportunities to directly assess him.  Given that Brandon was unable to engage in visual behaviors for a very long time due to the amount of work he was having to do to look, so we had just a few short sessions with him with direct assessment.  But the first session, we got a lot of information from him actually at the observation.  So let's look at the clips we got when we were videotaping Brandon's regular day in his classroom.

Eric: In this clip, you'll see Brandon engaged in a favorite leisure activity, playing the keyboard.  This is in his classroom under normal conditions after he's completed his morning routines.  Watch how he looks directly up at the light spontaneously, engaging in light gazing in very obvious fashion.

[Video Dialog]

We talked about it but,

yeah--

[Humming]

[end Video Dialog]

Eric: All right, so you'll want to come down to Row 6 on your CVI resolution chart and we'll mark about 1-2 for Brandon on this.

Sara: The next clip involves Brandon again, playing a fun interactive game with his TA, that's very familiar to him.  She has gone to get the whoopee cushion right before the clip starts.  And the whoopee cushion is a pretty, brightly colored, single-colored object that is familiar to Brandon because they do this all the time.  But she brings it into his best visual field from what we know so far which would be on his left side because that's where he has vision.  And he doesn't notice it at all.  As you're gonna see his response, he's pretty surprised.  But again, it's not something that's aversive to him.  You'll see later in the video.  It's something that he really enjoys.  And so, let's just watch this clip.

[Video Dialog]

[Blurts]

[Wheezing]

Oh, goodness. I'm sorry.

[Unclear].

[Mumbling]

Ah! Ah!

Charlie where-- Fetch!

[Mumbles]

[Tapping sounds]

[Laughing]

[end Video Dialog]

Sara: And so we're gonna mark that in complexity.  This is a complexity of environment issue since Brandon is playing, doing his thing,  He's in his zone.  He is not using his vision at all.  So let's mark that in Range 1-2.  Another thing that you're gonna want to note is that yellow is probably not one of his favorite colors.  Because when that thing came into his field, it was moving and it's, you know, one of those colors that's supposed to be, you know, one of the colors that kids with CVI respond to, right?  But it's not.  So yellow, I would say, you know, we're not going towards the yellow range from the information we have so far.

Eric: All right, this clip, you're going to see Brandon traveling down the hallway toward a really motivating activity for him.  And notice when the teacher is actually speaking, saying, "Left, right, left, right," you don't get too much visual activity.  He's really focused on that or auditory input, that stimulus, that's coming through his ears at that time.  Now when we have the teacher become quiet and take away that auditory input, we see Brandon actually raises head up and look about every three steps.  So without that auditory, he's able to use his vision much more effectively.

Sara: And he looks at you and you're a couple of feet away from him at that point, right?

Eric: I'm at least three to four feet away from him at that point, so.

Sara: So we're looking at complexity and distance in this one?

Eric: In this case, yes, definitely.

Sara: This one is one you gotta be really careful when, you know, it's just one of those things that this person, this teacher has bonded with this child.  She's doing things that are motivating for him because Brandon loves that silly kind of engagement.  That's a lot of verbal.  And sometimes you have to, you know, kind of decrease the fun a little bit when you're really wanting somebody to focus on using their vision.  So let's watch this video.

[Video Dialog]

Left.

Left.

Left.

Right.

Left.

Oh, off.

Uh-oh.

We're gonna scrape up

against the wall unless we change course.

[end Video Dialog]

Eric: So in this case, we're looking at visual complexity and at distance.  So you're going to want to mark in Row 5, about a Range 1-2.  And then mark in Row 7 for Distance at about a Range 3-4.  He was able to see me at about 3 to 4-foot distance.

Sara: Oh, it was that far?

Eric: It was, yeah, about three feet.

Sara: Okay.

Eric: And that was a really good point that you made about really balancing, what Brandon is motivated by, and how much we want him to use his vision because he is so much into the social aspect and the connection, being able to communicate on his level with his people.  And we want him to be able to do that but at the same time, we wanna build up his vision.

Sara: Yes.  So in this clip, you're gonna see Brandon getting to the end point of that, of all that walking, and it's a very motivating activity for him.  He talks about it a lot.  He gets to push the button and "button" is one of the words he says.  And the button is blue.  It's a single color.  And another thing that we're gonna look at other than color is complexity.  The background behind the button is very plain.  It's just one color.  So it's a pretty good contrast to the blue button.  One last thing about this is there's a novelty issue and that's something is happening that usually does not happen in his routine.  And that's me, videotaping him.  And so it's probably causing some distraction for him that this shape over here that's moving around, that's not usually there.  So let's look at this video.

[Video Dialog]

Button.

Yeah, that's where we are.

We're at the button.

All you got to do is reach out. You'll totally gonna find it.

I got you. I got you.

You are not gonna fall.

You're not gonna fall.

Here you go.

He's gonna reach in.

There.

[end Video Dialog]

Sara: So let's mark on the resolution chart, Row 1, Range 1-2.  Row 5, Complexity, Range 3-4.  And Row 9, Novelty, Range 1-2.

Eric: This next clip we wanted to show you because it was really the only time that we saw Brandon spontaneously use a visually guided reach.  He's using his reach and his vision at the same time to reach out for this familiar motivating activity, the big blue button. Let's take a look.

[Video Dialog]

Blue.

Are you gonna use that hand? Are you gonna use that hand?

Nice job.

Go ahead and push that button.

Push, push, push.

Push, push, push.

Push, push, push.

Give it a push.

Nice!

Oh, feel that cold air?

[end Video Dialog]

Eric: Okay, for this question, you'll want to come down to Row 10, Visually Guided Reach, and give Brandon a range of 5-6 on this.  He was able to use his vision and his touch at the same time, and also when his teacher was talking.  So he did have auditory stimulus coming in at the same time for this one as well.  Then you'll also want to come down to Row 5 for Visual Complexity and mark Range 3-4.  Both Sara and I were there, right in front of him, and he was still able to focus on that motivating blue button.

Sara: And that is the last clip in the observation.  So now we're going to go to our first direct assessment.

With Sara Kitchen and Lynne McAlister, Certified Teachers of the Visually Impaired.

Sara: Case Study 2 is about Cassie.  Um, Cassie, in these clips that we're gonna show you is 9-years-old.  She is diagnosed with CVI and secondary to anoxia that happened while she was having surgery as an infant.  Um, she also has an auditory processing disorder, and is labeled as deaf-blind.

She has developmental delays, speech impairment.  She's an extremely social child.  She uses an object calendar and there were thoughts at the same time of transitioning her to a picture calendar.  And according to her low vision report, she has intermittent nystagmus while tracking. 20/200 Snellen equivalent distance acuity.  Which was figured out using Teller cards.  She has also sight hyperopia but no glasses were prescribed to her at the time.

And we're gonna start with Cassie's parent interview.  If you would like to look at the parent interview answer guide in Christine Roman-Lantzy's book, feel free to do that.  The information that we're gonna be sharing with you is all in your handouts as well.  The questions and the answers, as well as the cheat sheet.  The only thing that we don't have in our handouts is the answer guide.  So, that's in the book.  So, you'll have all those things if you want to look at all those things.  One more form that you'll need to look at is the CVI Range. We're gonna be recording the scores for the parent interview, the observation and the direct assessment directly on that form. So, this is on your handouts, if you want to get that out, because it's good practice to start looking at that and start using it, and that's what we're gonna do. 

Lynne: And each...each individual assessment has a different color when you score it.

Sara: That's right.  We're going to be.  And if you noticed in your handouts, the parent interview will be purple.  And it will have a corresponding star on the chart for people who don't use their vision to see the colors.  And the observation video clips and corresponding things that we record on the chart will be green.  And will have a bullet next to them.

And the direct assessment clips will be recorded on, uh, the...

Lynne: Range?

Sara: No.  The resolution chart.  In red or with a little caret in front of the numbers.  So, just to give you an idea of what all that is, and you already have actually a resolution chart that's filled out in your handouts.

But if you want to get a blank one, so you could practice this along with us, it might be helpful.