Main content

Alert message

Lynne:
For the following case studies, you will need a copy of Christine Roman- Lantzy’s book, Cortical Visual Impairment, An Approach to Assessment and Intervention, copyright 2007, as we will be referring to it frequently.  We will be using some of the “Essential Forms” starting on page 187.  The first one is “The CVI Range”, which is seven pages long.  The second one is the three page “CVI Resolution Chart,” found further into the forms.   You may also use the data collection form we used if you find it helpful in assessing your students.  As you gain experience with the CVI Assessment or if you already have experience, you may find some other way of collecting data works better for you.  

You can make copies from your book and fill out Rating I and Rating II to find the CVI Range, as well as the CVI Resolution Chart, as we go.  You will need to have access to the book in order to do this, and it will be good to practice interacting with the Essential Forms.  

We found that the “CVI Resolution Chart” left us with some questions when it came to “Light Gazing and Nonpurposeful Gaze” at higher levels of resolution.  This is being revised and will be included in a new book by Christine Roman-Lantzy, which she hopes will be available within a year or two.

Broad overview:

Sara:
We chose students that had a diagnosis of CVI and fit roughly into Phases one, two, and three. We had each parent fill out an interview, and did a observation and direct assessment for each of the students. We videotaped each of those and then analyzed them together. Some of the characteristics of CVI are so subtle that without video, we would have missed so much. We would, however, caution against scoring from video alone.  Many things could be noticed only by being present.  Also, we cannot overemphasize the benefit of having two brains to help translate what we saw to each of the items on Rating 1 and 2.

Getting comprehensive information may be time consuming. We needed multiple videos in different environments to draw from. Also, student visual fatigue happened very rapidly after periods of sustained viewing, which meant we needed multiple short sessions.

Lynne:
We mentioned Sandra Newcomb's study in the Introduction.  This study was summarized in the American Foundation for the Blind's publication, the Journal of Visual Impairment and Blindness, October 2010, vol. 104, found on page 642. This study found, among other things, that the difference between Rating I and II was no more than 1.5 when assessors were highly trained.  If the range is larger than that, it is a sign that the interpretation of the test items should be examined more closely. This would be a good time to enlist the opinion of another TVI who has more experience in performing the CVI Range, to seek out more training opportunities, or to schedule yourself some time to intensively study Roman’s book.

Sara:
In our accommodations, we looked at nine areas, since the blink reflex cannot be addressed in programing, but resolves along with other characteristics naturally.  This should be addressed in the accommodations if a student fails to close his or her eyes when touched, because they could scratch their cornea on, for example, a blanket, if they do not close their eyes.  

Parent interview:  

Lynne:
All of our students were officially diagnosed with CVI, and some of the parents were generally knowledgeable about the characteristics that are associated with it. I think that this may be somewhat uncommon, as some of the interview questions seem to target parents of children who have not yet received a CVI diagnosis and have not learned about it.  Also, all of our students were school age, while some of the questions pertain more to small children or babies. We had to substitute words like “objects” for “toys”. Parents gave answers that sometimes pertained to CVI characteristics that weren’t targeted by the questions as defined on the Answer Guide to CVI Parent Interview Questions, appendix 4.A, in Roman’s book on page 41.  We recorded that information in our data sheets we created called “Interview Information.”

Indirect and direct assessment:

Sara:
We found that it was much more difficult to interpret some of the CVI characteristics of Phases 1 and 3, as opposed to  Phase 2. Brandon in Phase 1 was very very subtle with his responses, and it was hard to tell if he was seeing and what he was seeing. Ian in Phase 3 was at such a high level of resolution that the challenge lay in figuring out what he wasn’t seeing. Ian also had good conversational and social skills, as well as many reference points and visual skills from when he was fully sighted, which sometimes led us into thinking he had more vision than he actually did.

We will go through many items, and it will be much faster than it took us to initially compile and synthesize our data.  The pause button on the video player will be helpful if you need more time to process this information for yourself!  I know I would use it frequently.

Data Collection

Lynne:
CVI characteristics are not always easy to isolate, in that they are occurring at the same time and are often closely related to each other.  Many things that apply to, for example, distance, also apply to complexity.  Color is often a common thread, as is movement.  Many of our data points were recorded in multiple areas on the data sheets, such as when we asked Ian’s mother, “Does your child usually find objects by look or by feeling for them?” She answered,  “Most of the time by looking.  Sometimes when things are on the table I catch him feeling for items.  They had a big keys keyboard and he could tell you all the letters that were yellow.  Using his hands and using his eyes at the same time was difficult.”  That answer was recorded in color, field preferences, complexity and visually guided reach.  The point is that the same information may pertain to several different characteristics.

Rating 1

Lynne:
Once our data sheet was complete, we began transferring the information to the CVI Range Rating 1. We used the chart on page 97, Appendix 5.A, called, the “CVI Range Scoring Guide,” to help guide us through interpreting the data. When we were really having trouble deciding between two scores, we generally chose the all the time behavioral definition over the maybe sometimes definition. We went through a process we will explain within each case study to come up with a score for Rating 1.

Rating 2

Sara:
We then filled out the CVI Range Rating 2, using our data sheets paired with the CVI Resolution Chart as a guide for each of the 10 CVI characteristics. We added up the points and got a number, which was Rating 2. We then compared the two numbers (Rating 1 and 2). None of them had a greater difference than 1.5.  YEA!

PLVF/Accomodations

Sara:
Next we began creating what the TVI and classroom teacher would need to do to maximise their student’s use of vision, and those were the Present Levels of Visual Functioning and the Accommodations. Both of these can be used to create a CVI narrative, and this narrative is modeled several times in Christine Roman’s book.  Also, starting on page 118 of the book, there are examples of the types of environmental support that would be appropriate considering what kinds of visual skills the student is working on.  

Lynne:
When you find the Phase your student is in, that will direct you to what those skills are, for instance, Phase I kids are working on building visual behavior, or just  looking.  Phase II kids are integrating vision with function, or using vision, in conjunction with other senses, to act upon the world.  Phase III kids are really working on resolving their visual behaviors, and the environmental considerations will be very specific to specific tasks.

Sara:
Right, for example, kids are not ready to use two dimensional items (like photographs or Boardmaker pictures) meaningfully until they are functioning at a higher resolution level, so if you have a phase I or low to mid phase II kid using pictures to communicate, please reconsider either your CVI assessment findings or the meaningful use of pictures from the child’s perspective.  Is this visual input really meaningful or is it just what the adults find is the easiest modification to make?  

End (of beginning)

Lynne:
So we hope you find this process understandable and helpful when you are going through the assessment yourself. We feel like we got very good information about the visual abilities of each of our students, and were a lot better equipped to program for them. If you notice anything we missed, please comment!  Ok, now on to the case studies!