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

Lynne: The next area we're gonna talk about is resolution of CVI.

And we've been through some of the causes of CVI, what is CVI, what are certain things to look for, characteristics of CVI, and all of that kind of boils down to this. The idea that...if there has been damage to the brain, that because it is so plastic, the brain can rewire itself to learn how to do the tasks that that damaged area did in a different area. So, just as... If someone, you know... It's really accepted medical practice today that if someone has a stroke and loses their ability to walk, physical therapists probably on day two are getting that person up out of bed and they're practicing to walk. And they will practice, practice, practice until they relearn how to some extent. And so, if you just go one step farther with that theory, then someone who has lost vision due to brain damage, if you can get them to practice seeing, and practice, practice, practice. Eventually, their brain will rewire itself and they will learn how to see again, you know, to some extent. Some, you know, almost within a 100% and then, to various degrees. So, that's the really exciting thing about Christine Roman's work. It was to me. Just the idea that this is the one visual impairment that we, as teachers, of the visually impaired, can actually improve.

Sara: You can see change over time.

Lynne: Right. We can improve someone's vision through systematic teaching.

Sara: Right. With most of the visual impairments, you find an adaptation that works for this visual impairment.

Lynne: Right.

Sara: And that's pretty much what you do through, you know, what you need to do for this child. They may learn new technologies and new things like that, but the actual condition is, you know, very cut-and-dried. You know what you're supposed to do for that. With kids with CVI, you're gonna be adapting a certain way and then you're gonna be adapting in a different way based on what you know of the child later.

Lynne: So, it is a very exciting area of study. Christine Roman says that the best chance for resolution... And we talk about...That was her term resolving CVI, it's a process. And so, she talks about stages of resolution. She says that the best time for a resolution is within the first three years of life. And some of the research I did, it did show that, you know, adult brains also are able because they remain plastic throughout your lifetime and they are able to change and take over different functions.

So, I would, you know... The first three years might be the prime time, but there's always chance for change and improvement.

Sara: For the first three years after the injury, too.

Lynne: After the injury.

Sara: But, yeah, improvement is still possible for adults even, which we’re learning and really appreciating. Because it's nice to know that we can still change our brains...

Lynne: Right.

Sara: ...later in life.

Lynne: And so, you know, the intervention is structured. It's not just, you know, a haphazard, or Willy-nilly or just their vision will get better.

Sara: It's not vision stimulation.

Lynne: Right. Their vision just won't get better just by seeing everyday things, you know, it's pretty structured. And there's three phases of resolution: Phase one is learning how to look at something. And those are the students that appear to be the most visually impaired. They really don't seem to...they don't know how to look at anything.

Sara: Right, right. And what's really important about determining where their phase is, is that if your interventions are at a phase where it's not helping organize the environment and also that the student can visually process, then it's like you're not even starting to do that. So, this is what we wanna know about phase one. We want the child to just look. We wanna give them things that they can look at, so that their brain can repeat that experience over and over again. And so that they can get that solidly, build those connections in their brains, and build solid visual connections. So, once they have done that and they can look at a certain number of items, the next phase is integrating vision with function. And that's when I was talking about, you know, we were talking about all of the senses and integrating the senses...

Lynne: Uh-hmm.

Sara: And, um, I think this is a huge thing because other senses could also be a little miswired as well... But this is the time when you see something and you act on it. You learn about not... You can look now. So, you look and then you find out more information about the object by getting information through your other senses. So, first you learn how to be able to look at all, and then you’re learning more about connecting that information with the other things that you learned about the objects at the same. And again, repetition. We have to do it over and over and over again.

Lynne: Right. And then, as you move in to phase three, this is the final phase of resolution, and this really deals with complexity. Complexity is the big characteristic that is...

Sara: And distance, right?

Lynne: And distance.

Sara: 'Cause they're closely related.

Lynne: Right. It's the hardest one, I guess, to resolve completely. We live in a real complex world, and so...

Sara: Things are changing all the time.

Lynne: Right. And there's a lot of stuff out there. So, um, this is... Phase three is less interference from the CVI characteristics. And I also think it's important to remember that you know, as teachers, we're taught in school, that the way to teach something is you assess. You find out what the student knows, and then, you find out what's the next thing they need to know. And that's what you teach. And that is not the way you go about remediating for CVI.

Sara: Right.

Lynne: You assess, you find out what the student can see. But then, you don't jump to..."Okay, now. What they can't see, that's what I'm gonna focus on." You need to focus on what they can see because they have to rewire their brains through practice and through seeing. It's nothing that you're gonna be able to do. So, you figure out, you know, you assess, you find out what they can see, and then you enrich the environment with what they can see. So, that they can get more and more practice seeing it.

Sara: Uh-hmm.

Lynne: And then, you know, then they themselves will move to the next step.

And hopefully, begin adding things in that they can see or, you know, start integrating some of those senses of what they can see. And once you start seeing that, then you add that in to your enrichment of environment.

Sara: Yeah. 'Cause I really feel like that from watching kids. I feel like people are driven to organize. Their brains want to make sense of information. And kids will find, you know...if they can begin, if they can get started, then they're going to be trying to do these things that organize their brain. Such as, when we're watching Cassie play with her accordion. She has... Its stripes, but it's multicolored, and it's making sound, and she has a hard time looking at stuff and listening at the same time.

However, you see her playing it and then glancing down. And then, looking up again. She's trying. She wants to be able to do that. And so, we're making it easier for kids to do what they're already doing, basically. When you think about the kinds of things that resolve, some of the....The earliest things that resolve are probably light gazing...

Lynne: Uh-hmm.

Sara: ...their reflexive response of the blink to the touch, that's just a closer one in blink to threat. So, those are both along the spectrum, though. And the mid-resolution sorts of things are they're able to look at more colors, the latency decreases, they are able to look at more things that they are unfamiliar with. And there's still resolving that blink reflex.

So, the blink to threat becomes more resolved. And, um, they're not as drawn to movement. And the last thing that resolves are the visual fields.

They're able to look at things not only in their preferred field.

And, um, the visual motor, they're able to integrate those senses better.

Complexity, like Lynne was talking about and then distance, which is related to complexity. One thing I thought was really...

This quote that I have here from Blind Babies, the Blind Babies Foundation Fact Sheet. It's really pertinent to what we're doing and what we have to think about all the time with these kids. And I will read it to you.

"When a child with CVI needs to control his head, use his vision, and perform fine motor tasks, the effort can be compared to a neurologically intact adult learning to knit while walking a tightrope." So, we really need to think about what we're asking these kids to do.

Lynne: Uh-hmm. So, we have case studies for three students: a phase one, phase two and phase three student.

Sara: And those studies are using Christine Roman's assessment. And so, what we're gonna look at next before we show you these case studies is the actual assessment that's in her book. That's available through AFB press. You might wanna get a copy of it. It would be very helpful in doing this. I don't think I could've done any of these without it. So, we're gonna look at some of the forms that she uses and the process that she uses. We're not gonna look at every single solitary thing in her book, of course. But that's what we're going to look at during the next section.