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Lynne:
The CVI Resolution Chart can be a quick reference guide to use when developing the IEP to accommodate and support a student's current visual functioning. Following the directions at the bottom of the page, we will draw an "X" through boxes that represent resolved visual behaviors, use a highlighter to outline boxes describing current visual functioning, and draw a circle in boxes that describe visual skills that may never resolve due to coexisting ocular conditions. The highlighted boxes correspond with the scores given on Rating II.

Sara:
For Cassie's CVI Resolution Chart, in the first row, color, we put an "X" in the first box, "Objects viewed are generally a single color," because Cassie looks at things that have more than one color. We put an "X" in the second box, "Has 'favorite' color," because she did not seem to show a color preference. In the third box, "Objects may have two to three favored colors," we also put an X, since Cassie showed no color preference, and would look at a small variety of items that had two or three colors. The next box, "More colors, familiar patterns regarded," was what we highlighted, since Cassie seemed to be interested in many colors and especially in the familiar stripe pattern.

Lynne:
In the second row, need for movement, we marked the first and second boxes with "Xs," because Cassie was able to look at things that didn't move, though we found movement definitely helped her to visually attend, particularly when there were high levels of complexity. We highlighted the third box, "Movement continues to be an important factor to initiate visual attention."

Sara:
The third row, visual latency, presented a question of ocular vs. CVI characteristics. We definitely saw Cassie looking at most things immediately. She was able to locate these targets, and demonstrated that by reaching for them after she had seen them. If the target had high levels of complexity and was new to her, however, she did not study it. So we marked "X" in the first two boxes, because we did not see latency in most situations. We did see it after we had asked her to look at a lot of new things in a non-routine testing session. She became tired and her looking behaviors decreased. By the end of the testing session, it seemed to take her quite a while to decide to study a visually simple item that produced movement, and when she did look, it was not for long. So we highlighted the third box in that row, "Latency present only when student is tired, stressed, or overstimulated." We circled the next two boxes because, according to her eye report, Cassie has intermittent nystagmus. Nystagmus can also cause decreased looking if the student is tired, stressed, or overstimulated.

Lynne:
In the fourth row, visual field preferences, we marked an "X" in the first box, "Distinct field dependency," because we did see Cassie respond to highly stimulating things in her peripheral fields. We highlighted the second box, "shows visual field preferences," because Cassie needed non-shiny or static things placed in a specific spot to see them. Even a very favored item could not be detected slightly out of her best field, which was her lower central field.

In the fifth row, we found that Cassie could definitely use her vision when there were low to medium levels of background noise, though sometimes this would increase the difficulties in other areas, such as looking at touching at the same time. We marked an "X" in the first two boxes, and highlighted the third box, "Student tolerates low levels of familiar background noise. Regards familiar faces when voice does not compete." This last statement in particular really seemed to describe Cassie's behavior.

Sara:
The sixth row, light-gazing and nonpurposeful gaze, we thought about for quite a while. When Cassie is busy doing something, she does not seem to be distracted by light, though she does respond to it by squinting for short periods of time. She may take a brief time out to look at a light in a totally new and out-of-routine situation like when we pulled her out of her classroom to do some direct assessment, but in general, when she is working on something, she does not get distracted and stop looking at other things because of light. When she does take a break she easily redirects herself back to the activity at hand. So we put an "X" in each of the first two boxes and highlighted the third box, "Light is no longer a distractor."

Lynne:
In the seventh row, "Difficulty with distance viewing," we marked "Xs" in the first three boxes because we definitely noticed Cassie seeing objects beyond 6 feet if they had movement qualities. We highlighted the box, "Visual attention extends to 10 feet with targets that produce movement."

The eighth row, "Atypical visual reflexes" we mulled over for a while. The first two boxes we obvious Xs, so we marked those that way. We really noticed that Cassie always blinked when an open hand came toward her face. So that would not be an intermittent response. That caused us to put an "X" in the third box as well. We then highlighted the next box, "Visual threat response consistently present (both reflexes near 90 percent resolved)."

Sara:
The ninth row was interesting. We presented Cassie with a number of new objects. She did not study many of them, particularly the ones that were challenging due to complexity of the target, but she was able to detect and respond to them. Sometimes, she just knew something was there, and reached in the general vicinity to find it tactually. Sometimes she reached directly toward a novel item if there was a plain background. So the novelty of the item did not seem to present a problem as far as detecting it visually. We put an "X" in each of the first four boxes and highlighted the last box, "Selection of objects not restricted."

Lynne:
In the last row, absence of visually guided reach, we put an "X" in the first two boxes because Cassie was able to look and touch at the same time particularly when items presented were familiar or had movement qualities against a non-complex background. We highlighted the third box, "Visually guided reach used with familiar objects or 'favorite' color." The "familiar objects" part seemed very important, though "favorite color" was not really an issue.

Sara:
Now we'll look at the forms in the back of Christine Roman's book, 2 pages after 185, or maybe page 187, called "Essential Forms." The part we'll fill out first is called "The CVI Range: The Across-CVI Characteristics Assessment Method", or "Rating I". We'll compare the notes we have taken from all of our information sources to the "CVI Range Scoring Guide" which is on page 97, or appendix 5.A. On the CVI Range Scoring Guide in the column marked "Characteristic," you will be directed toward the section of your data collection form where you might find supporting information.

We found all the scores in the first section, "CVI Range 1 to 2: Student functions with minimal visual response," to be marked in the "R" column. The characteristics at this level we found to be resolved.

Lynne:
In the second section, "CVI Range 3 to 4: Student functions with more consistent visual response," we still have some characteristics that were resolved, but not all. The first statement, "Visually fixates when the environment is controlled," we marked as Resolved, because the statement from the "CVI Range Scoring Guide" which seemed to best describe Cassie's visual functioning we found under the "R" column: "Establishes eye-to-object contact with familiar or novel objects or human faces, even in the presence of visual or other sensory stimuli." We found support for this in the complexity section of the observation data collection sheet.

Sara:
For the second statement, "Less attracted to lights; can be redirected," we found the stipulation to be true under the plus column, so we marked her with a plus: She "may stare at lights, but is able to shift attention from lights when appropriate visual targets are presented in controlled environments." This information was found in the "light" row of the observation and direct assessment data collection sheets

For the third statement, "Latency slightly decreases after periods of consistent viewing," we noticed that Cassie did not exhibit delays in looking at familiar items, but did sometimes with novel items, if she was tired. We found that out from the latency section on the direct assessment sheet. We marked that as resolved in the column described as, "A delay in directing vision toward a familiar object is rarely, if ever, present."

Lynne:
The fourth statement, "May look at novel objects if they share characteristics of familiar objects," we marked as resolved because Cassie regularly was "able to glance toward or have eye-to-object contact with objects never previously seen that may or may not resemble 'favorite' objects." We found that information from the observation and the direct assessment in the area of novelty.

The fifth statement, "Blinks in response to touch and/or visual threat, but the responses may be latent and/or inconsistent" seemed like a pretty good description of what Cassie did during the direct assessment, in that her response was just a little slow. We found the plus description to be consistent with that: "Blinks to touch at bridge of the nose and possibly to the quick movement of a target toward the face, but responses may be delayed or slightly inconsistent."

Sara:
The sixth statement, "Has a 'favorite' color" definitely seemed resolved. We marked it in the "R" column, which is described as, "Visual attention to objects is not dependent on a particular color." This was supported by information from all three data collection sheets in the area of color.

The seventh statement, "Shows strong visual field preferences," we found to be true as described in the plus column, "Glances toward or has eye-to-object contact with targets when presented in specific positions of peripheral and/or central viewing fields." We found support for that in the corresponding row on all data sheets.

Lynne:
The eighth statement, "May notice moving objects at 2 to 3 feet" we marked in the plus column because we saw that Cassie "Glances toward or has eye-to-object contact with objects that move in space or are made of shiny or reflective materials and are at distances up to 3 feet." We did not see that she could see things that did not have these qualities beyond three feet. We found support for this in the movement, distance, and complexity sections from all data sheets.

The ninth statement, "Look and touch completed as separate events," we marked in the plus-minus column because we saw that Cassie "Occasionally uses visually guided reach." We found support for this in the "visually guided reach" section of all data sheets.

Sara:
In the next section, "CVI Range 5-6: Student uses vision for functional tasks," we continued to find some that were resolved. For the first statement, "Objects viewed may have two to three colors," we found the resolved description to be the most true from all the data collection sheets in the areas of color and/or complexity, because Cassie "Pays visual attention to multi-color or multi-pattern objects, with or without preferred color."

For the second statement, "Light is no longer a distractor," we found the plus-minus description, "Occasional gazing at primary sources of light," to be the most true, with support from information in the row called "light" on all data collection sheets.

Lynne:
The third statement was, "Latency present only when the student is tired, stressed, or overstimulated." We found the plus-minus description to be the most true according to information from the rows on latency and complexity in the direct assessment data, in that Cassie exhibits an "Occasional delay in directing visual attention to a target."

The fourth statement, "Movement continues to be an important factor for visual attention," we found, in the plus-minus column, "A small element of movement may help establish or maintain visual attention," to be the most true for Cassie, which was supported by data from all collection sheets in the area of movement.

Sara:
The fifth statement, "Student tolerates low levels of background noise," seemed to best describe Cassie in the plus-minus column, "Occasionally is able to maintain visual attention in the presence of sound. One or two particular sounds are tolerated during viewing; many are not tolerated." This was supported by our notes from the observation and direct assessment information on complexity.

The sixth statement was "Blink response to touch is consistently present." We marked that one as resolved, which read, "Blink-to-touch response present; blink-to-visual-threat response (when target moves quickly toward face) inconsistently present." We found this in our notes on visual reflexes on the direct assessment information sheet.

Lynne:
The seventh statement, "Blink response to visual threat is intermittently present" we also marked in the resolved column, since Cassie's "blink to visual threat response" is "consistently present," even if it is sometimes slow. This information was in the visual reflexes row of the direct assessment information sheet.

In the eighth statement, "Visual attention now extends beyond near space, up to 4 to 6 feet," we marked a plus. Cassie "can visually locate or fixate on certain targets at distances as far as 6 feet away," and her "ability to detect objects or movement at 4 to 6 feet may depend on the degree of environmental complexity," as stated in that column. We found support for this in the area of distance in the observation and direct assessment information sheets.

Sara:
The ninth statement, "May regard familiar faces when voice does not compete" we found to be a plus. This is described as "Glances or looks directly into faces of familiar people, but only when the familiar person is not speaking." That description seems to be dead-on for Cassie, which we saw more than once during the observation.

In the next section, "CVI Range 7 to 8: Student demonstrates visual curiosity," we no longer found items that were resolved, but did still find a few plusses. The first was one of those: "Selection of toys or objects is less restricted; requires one or two sessions of 'warm up'." The plus statement in the CVI Range Scoring Guide was, "Looks at new objects that have attributes of familiar objects. Recognizes new object immediately after one or two presentations." We interpreted recognition as visual attention, since Cassie doesn't verbalize most of her thoughts. In our notes about the observations and direct assessment, we found supporting data in the areas of complexity and novelty.

Lynne:
The next statement was, "Competing auditory stimuli tolerated during periods of viewing; the student may now maintain visual attention on objects that produce music." We marked this as a plus-minus because the description, "Occasionally is able to maintain visual attention while other sensory input competes. Particular types of sensory inputs may continue to interfere with visual attention," was accurate for Cassie. We noticed Cassie using her vision in some familiar noisy environments, like the cafeteria and during her hygiene routine, during the observation. Other times during the observation, low-level noise, even if it was familiar, seemed to interfere. There were notes alluding to this in the observation information sheet in the area of complexity.

Sara:
The next item, "Blink response to visual threat consistently present," seemed to best describe Cassie with the plus statement from our direct assessment notes in the section on visual reflexes, which was, "Blinks simultaneous to the approach of an object or open hand moving quickly on midline toward the face." So we marked it as a plus.

For the statement, "Latency rarely present," we found the plus-minus to be a better description of Cassie's behavior, which was, "Seldom demonstrates a delay in detecting a target after it is presented." We mainly saw a quick visual response to all sorts of targets during the observation and direct assessment, even if the response was brief, except for when Cassie was tired. This data was gathered by considering visual behavior patterns across multiple observations; there was not a single clip that gave us this, it was more the summation of all the clips.

Lynne:
The statement, "Visual attention extends to 10 feet with targets that produce movement," we found to be a very good description of Cassie. We marked her in the plus column, which was, "Is able to visually locate and/or fixate on certain targets at distances as far as 10 feet away, especially with targets that produce movement. Attention at this distance may depend on the degree of complexity of the environment." We found that during the observation, in a familiar location -the classroom- Cassie could find things that move. She also moves a lot herself, which may be helping her find things. These notes were also on the observation information sheet in the area of distance.

Sara:
For "Movement not required for attention at near distance," we found Cassie to be best described by the plus-minus statement, "Occasionally is able to detect and attend to visual targets beyond two feet." This one was a hard call since Cassie moves herself so much, and when we did see her being still and detecting items that were beyond 2 feet, they often had movement qualities, but some familiar ones did not, such as her accordion. Cassie is also able to travel successfully indoors visually, and maneuver around items without tripping for the most part. We found support for our choice of the plus-minus statement in the direct assessment information in the areas of movement and distance.

Lynne:
For the statement, "Smiles at/regards familiar and new faces," we found the plus-minus again to be the best description, which was, "Occasionally glances toward and/or makes eye contact with familiar faces." We found this in the interview and observation data collection sheets in the area of complexity. Cassie did not look at her less familiar assessors at all during the direct assessment.

The statement, "May enjoy regarding self in mirror," was a tricky one. We weren't sure whether Cassie was looking at herself in the mirror, exactly, or if she just had a social script about mirrors, (such as, she has learned when you see this shiny flat thing you put your face on it and say your name). It seemed as if she was looking for a little bit, so we thought the plus-minus, "Inconsistently glances at own image in mirror," was the best description from the direct assessment information sheet in complexity.

Sara:
For the statement, "Most high-contrast colors and/or familiar patterns regarded," we thought the plus-minus column, "Is able to visually attend to some simple patterns, especially familiar ones or those that are highlighted with the preferred color," best described Cassie. Cassie doesn't seem to have a preferred color, but she seems to find items that are one or two colors, rather than three or more, easier to visually attend to, and she seems very interested in stripes. Stripes with many colors seem to be too complex to visually study at this point, though Cassie really tries. We found information on this in the color, complexity and novelty sections of the observation and direct assessment information sheets.

Lynne:
The next statement, "Simple books, picture cards, or symbols regarded," also seemed to be most applicable to Cassie in the plus-minus column, which is, "Visually attends to a small set of two dimensional materials; is not able to generalize the images to new contexts." Cassie did not seem to really attach much meaning to the 2-D items we saw her look at. She seems to be just beginning to look at non-complex 2-D items. We found information on this in the novelty and complexity sections of the observation.

Sara:
In the next section, "CVI Range 9 to 10: Student spontaneously uses vision for most functional activities," we marked the minus for all items except the following two, which were plus-minus. In the second row, "Only the most complex environments affect visual response," Cassie seemed best described by the plus/minus description, "Demonstrates visual curiosity in familiar environments that have low degrees of sensory complexity." We found support for this in the complexity and/or novelty sections of all areas of data collection.

Lynne:
In the eleventh row, "Look and reach completed as a single action," the choice that best described Cassie was again the plus-minus, "Uses visually guided reach only when the background complexity is reduced." Cassie used visually guided reach on a plain background when the complexity of the target was lower, or when the item had movement qualities. There was only one time when she was able to find a very familiar item on a complex background and reach directly toward it. We found data to support our choice in the visually guided reach section on the direct assessment information sheet.

Sara:
There is one minus you may have a question about if you continue to compare the information from our data collection sheets to the statements in the CVI Range Scoring Guide. For the description, "Visual attention extends to beyond 20 feet," we realized that we didn't have any data. We went back and asked Cassie's teacher if she had seen Cassie looking at anything 20 feet away or more. The teacher said that Cassie doesn't do that during any of their classroom activities inside or outside, so we went ahead and marked that one as a minus from interview information. The rest of the minuses should be evident from notes on the data collection sheets.

Lynne:
On page 61 of "Cortical Visual Impairment" Roman wrote, "The individual statements that describe visual behaviors are matched to the child's visual responses and scored until a 'ceiling ef-fect' has been reached. A ceiling effect occurs when the pluses that indicate the student's current level of functioning end, and a cluster of minuses occur for four or more consecutive items. The minuses indicate that the student has not yet reached the level of functioning described in that range. The student's score of the assessment is determined by the number of the CVI Range in which the last plus item occurs prior to the shift to scores of plus-minus and minus. Since each group of statements is identified by a range of two scores, the lower number of the range is assigned if the plus statements end in the middle of the cluster, the higher number is used if the plus-scored statements are marked to the end of the cluster."

This would put Cassie in Range 7 to 8, in which she had 4 plusses and 6 plus-minuses. We would pick the lower number, since plus statements end in the middle of the cluster, not the end. So we wrote Cassie's Rating I score as a 7.

Sara:
The next section is called Rating II, the "Within-CVI Characteristics Method." The numbers stand for "not resolved" at 0, and in increments of .25, stand for various levels of resolution up to 1, which means "Resolved." These numbers correspond with numbers on the top row of the CVI Resolution Chart. The CVI Resolution Chart can be found at the end of the book within the forms in the same section as the CVI Range Ratings I and II. Rating II can be completed by matching the level of resolution described on the Resolution Chart of each characteristic that best depicts the child. Each characteristic is given a number, and after that, the numbers are added up to find a value for Rating II.

For number 1, color preference, we found that Cassie was able to detect items with multiple colors or crazy patterns, but she didn't really attend to or examine them unless they were just a couple colors, or had a "striped" pattern. We scored this characteristic as .75 (Range 7 to 8).

Lynne:
For number 2, need for movement, we found that the description, "movement continues to be an important factor to initiate visual attention," was right on the money for Cassie, so we scored this one as .5 (Range 5 to 6).

For number 3, Visual latency, we found that Cassie only seemed to take longer to look when she was tired, such as when we asked her to look at lots of new things out or her routine for a sustained amount of time. We scored that one as .5, (Range 5 to 6).

Sara:
For number 4, Visual Field Preferences, we found that Cassie only seemed to notice her non-moving, striped, but extremely familiar and favored accordion in her best visual field, which was lower and central. She noticed moving or supercharged shiny things in her peripheral fields. We marked this one as .25, (Range 3 to 4).

For number 5, Difficulties with visual complexity, we found that Cassie was able to tolerate low levels of familiar background noise and that she would occasionally look briefly at familiar faces, but only if those people were not talking, so we marked this as a .5, (Range 5 to 6).

Lynne:
For number 6, Light-gazing and nonpurposeful gaze, we thought that Cassie wasn't that distracted by lights because she always self-directed her visual attention away from lights to other targets. We marked her as .5, (Range 5 to 6).

For number 7, Difficulty with distance viewing, we found that Cassie was definitely able to see things beyond 10 feet if they were moving or if she was moving, so we scored that one with a .75 (Range 7 to 8).

Sara:
Number 8, Atypical visual reflexes, was best described in Range 7 to 8, "Visual threat responses consistently present (both reflexes near 90 percent resolved)," which would make that one a .75.

For number 9, Difficulty with visual novelty, we found that the statement in range 9 to 10 best described Cassie, "Selection of objects not restricted," in that she could detect almost any novel object. For her to study or examine objects visually, there were more requirements in the areas of color, complexity, and movement. So we would definitely want to think about those characteristics when choosing items for functional routines. We marked her as a 1.

For the last one, number 10, Absence of visually guided reach, we noticed that Cassie uses visually guided reach best with familiar objects, so we marked her as a .5, (Range 5 to 6).

Lynne:
So adding up all ten numbers, .75, .5, .5, .25, .5, .5, .75, .75, 1, and .5, we got a total of 6. Cassie's score for Rating II was recorded on the first page as a 6, making her CVI Range from 6 to 7, with a difference of 1. If you look at the very top of the CVI Resolution Chart for reference, it appears that Cassie's visual abilities fall into the high Phase II CVI Range, "Integrating Vision with Function."

Lynne:
For the direct assessment, we took Cassie out of her busy classroom to a quiet, visually non-complex room and presented her with many novel items to look at. We also brought her favorite toy, an accordion, along for comparison. Cassie was able to look at new items and play with us for a while, but the session definitely seemed to tire her out toward the end. We were able to get a lot of information from our interview and observations as well, so we only ended up asking her to participate in one direct assessment session.

Sara:
In clip 1, we see Cassie reaching for a pan, an item her teacher told us Cassie likes to play with in the classroom. In a complex array, Cassie located the general area of the item visually and aurally, then searched tactually to pick it up. It may have been that she was actually reaching for the accordion.

[video clip 1]

>>Teacher 1: Doo-doo-doo-doo-doo. Bang bang bang. Bang bang bang.

>>Teacher 2: Underreached, totally. Or overreached.

Sara:
We marked that on the sheet called "Direct Assessment Information" in "Complexity" and "Visually Guided Reach."

Clip 2 shows Cassie looking up toward the overhead light, taking a break from looking.

[video clip 2]

>>Cassie: Ah! Ahhh!

>>Teacher 1: Ahhh!

[Cassie clapping]

>>Teacher 2: Yay! Where's the bang bang? Where'd it go?

[Teacher 1 banging on pan, then Cassie laughing.]

Sara:
We marked that in "Light."

Lynne:
Clip 3 is a long one and contains a lot of information. We see Cassie interacting with a number of items in a complex array. It seemed like she needed to clear the area before she could find her favorite item, the accordion. Often she uses a combination of vision, to detect that something is there, and then searches tactually to find the exact location, particularly with multi-colored items. She is able to reach correctly toward a blue item that has movement qualities and toward a white and black item on a black background. She briefly examines a black and white item up close. All this time we are providing a cheering section, also known as teacher noise! This was fun, but may have interfered with Cassie's ability to look. Many things to watch here in clip 3.

[video clip 3]

>>Teacher 1: Bang bang.

>>Cassie: Bang bang bang.

>>Teacher 2: Oh, the ball. Ooh!

>>Cassie: Yay!

>>Teacher 1 and 2: Yay!

>>Teacher 1: You got it.

>>Teacher 2: [laughing] Yay! Oooh...

>>Teacher 1: Ookie.

>>Teacher 2: Plop.

>>Teacher 1: Oop! Oh. Up! Ohhhh!

>>Cassie: Ooohhhh!

>>Teacher 1: Ooohhh!

>>Cassie: Cassie's?

>>Teacher 1: That's Cassie's!

Sara:
We recorded this information in the rows for "Color," because Cassie examined the black cow with white spots. She did not look at other novel multi-colored items except the blue koosh ball, which was moving. We recorded that in "Need for Movement," because the moving koosh definitely drew visual attention. We also marked "Complexity," because she did not seem to be able to locate her favored item until clearing the table. She seemed to visually know items were there but then had to tactually locate them, which could have been due to the complexity of the array. We also marked this information in "Visual Novelty" because she was able to briefly look at some of the testing items, which were unfamiliar, and was able to visually detect that other novel items were on the table, even if unable to determine the exact location, and in "Visually Guided Reach," because Cassie reached directly for a novel moving item and for her favorite, familiar accordion without looking away. She was able to visually locate other items but then could not reach directly for them, except one, which was a slightly shiny white item on the black background. That clip sure did give us a lot of information, Lynne!

Lynne:
In clip 4, I present a shiny reflective mylar thing in Cassie's left, right, and upper peripheral fields. Cassie seems to detect the item in the periphery and then turns her head to view it in her best field. Sometimes the item is up to 2 to 3 feet away. Cassie detects it every time.

[video clip 4]

>>Cassie: Turn off? On. Hi. Bye.

>>Teacher: Bye.

>>Cassie: Off? Are off?

>>Teacher: They're off.

Lynne:
We marked this in "Need for Movement," and in "Field Preferences," since she was able to detect the highly see-able item when it wasn't in the best field. We also marked this in "distance viewing."

In clip 5, from about four feet away, Cassie locates and reaches directly for her favored item on an extremely visually cluttered background with low environmental complexity. It is not apparent whether she is keeping her eyes open while reaching and finding the accordian.

[video clip 5]

>>Cassie: Hi.

>>Teacher: Ha ha ha. I see.

Lynne:
We marked this in "Complexity" and in "Distance viewing."

Sara:
In clip 6, Lynne is holding Cassie's accordion just to the left of Cassie's best visual field. Cassie does not seem to know it is there at all until she turns her head. You can see her hands expressing delight the moment she sees it.

[video clip 6]

>>Teacher: Ready? Set!

>>Cassie: Sit down?

>>Teacher: Sit down? [Cassie laughs.] Then it just appeared over there all of a sudden. Ready? Set!

>>Cassie: Go!

>>Teacher: Go!

Sara:
We marked this in "Field Preferences."

In clip 7, Cassie is enjoying one of her favored interactions with an adult, which is to have someone play the accordion while she watches their arm. We throw a kink into it by putting multi-colored stripes on the arm in the form of a long glove, to see if that will make Cassie want to look more or less. We see a mix of behaviors. It seems like Cassie tries to look at the striped arm for about 10 seconds (she stops when she hears a funny sound), then later she tries blocking out the novel striped arm, or at least part of it, by putting her hands over it.

[video clip 7]

>>Teacher 1: Ready? Set! Go!

[Teacher 2 sneezed. Cassie laughs.]

>>Cassie: Hands up. Hands up.

>>Teacher 1: Sara's turn. Is she looking at it?

>>Teacher 2: Kind of blocking it with her hands.

Sara:
We marked that one in "Color," since she sort of looks, in "Need for Movement" because the movement seems to draw her visual attention, in "Complexity" because she is able to look while the accordion is playing when the target is complex, but then has enough, and tries to block out some of the colors. And we marked "Novelty" because she does seem to look at the new item, even if indirectly.

Lynne:
Clip 8 is interesting: Sara presents Cassie with a mirror to look at. Cassie seems to try to look at it but it's hard for her. It may be the reflective quality or the movement inside the mirror that she is drawn to, but she squints and looks away. She asks for the lights to be turned off, and after the lights are off, she looks at the mirror much in the same way she looked at other 2-dimensional items, except her face is right against it. She only looks for a little bit. She seems to know the social script of how we interact with mirrors, in that she labels herself in it. It is hard to tell if she can actually identify that it is her own face in the mirror or if she is even looking at her face at all.

[video clip 8]

>>Teacher 1: What's that?

>>Cassie: Off?

>>Teacher 1: Who is that?

>>Cassie: Turn it off?

>>Teacher 1: Cassie! Who's that?

>>Cassie: Turn off!

>>Teacher 1: Lights off?

>>Teacher 2: It's hard for her to see. She looks at it and she's immediately squinting.

>>Teacher 1: Ok. Off.

>>Teacher 2: No, I mean that mirror.

>>Teacher 1: Oh, the mirror's too bright?

>>Teacher 2: I don't think it's too bright. I think it's hard for her to look at. Can you angle it so it's reflecting her movement so she can see it? That might attract her attention.

>>Cassie: Cassie!

>>Teacher 1: There's Cassie! Hi! There you are. Hi!

Lynne:
We marked our observations in "Need for movement," since the reflective mirror does draw visual attention; in "Complexity," because she needed to reduce complexity by dimming the lights before she could identify and participate in the mirror social script, and because of how close she got to the mirror- perhaps to block out some of the complex background. We also marked this one in "Light," because the mirror acted as a light source at times and drew her visual attention and caused her to squint.

Sara:
Cassie is getting pretty tired of our shenanigans by the time we're to clip 9. But she's a good sport. I present her with a black fan and she glances toward it briefly and then actually seems to look for a little longer after about 10 seconds. Then after another similar time period she takes it and looks closer. Even though it's a single-colored item with movement properties, Cassie still has a hard time looking after all the work she's been doing. Let's watch.

[video clip 9]

>>Teacher 1: Are you over it? What about this?

>>Cassie: One.

>>Teacher 2: Oh, she thinks your arm is moving it.

>>Cassie: Two. Off.

>>Teacher 1: Off? On.

>>Cassie: Cassie! Off, off, on?

>>Teacher 1: The lights off? You do it? Can you reach 'em? I'll show you.

Sara:
We marked that one in the row for "Visual Latency" because of the amount of time it took her to look at the fan and because of the fact that she's definitely showing signs that she is tired.

Lynne The last clip, clip 10, involves Sara rapidly bringing her open hand toward Cassie's face to test her blink to threat reflex. Cassie blinks the first 2 times and her response is a tiny bit slow.

[video clip 10]

>>Teacher: Looks pretty good. It's a little slow, but pretty good.

Lynne:
We marked this data in "Atypical Visual Reflexes"

Sara:
Now we'll look at clips from video we took when we were observing Cassie in a familiar environment: her classroom. Most of the clips are during Cassie's regular routines. We did have a little time to try some things with her in her classroom, which is when you'll see her playing with me and Lynne. We recorded our thoughts on the sheet called "Observation Information"

In clip 1 we see Cassie playing with a keyboard and not looking at her actions at all. It isn't apparent whether the keyboard was making any noise. We can definitely hear another electronic toy that doesn't seem to be controlled by what Cassie is doing. Let's watch clip 1.

[video clip 1]

>>Cassie: Stand up.

Sara:
So we marked that one on our Observation data sheet under "complexity" since the sensory environment, tactual and maybe auditory, seemed to compete and win out over Cassie's use of vision.

Lynne :In clip 2 we see Cassie checking her calendar with her teacher. Her teacher has paired an object with a picture for the activity that they are "finishing," which I believe they refer to as "Listen." The picture is a single color photo of a pinkish-red colored square on a black background, probably a cd case, and it is very non-complex. It is also laminated and shiny, which may play a factor in Cassie's looking, if she is drawn to things that are shiny. Cassie brings the photo close to her face and tilts her head slightly back while looking. Let's watch clip 2.

[video clip 2]

[stomping sounds]

>>Teacher: CD?

>>Cassie: Is...finished.

>>Teacher: Finished?

Lynne:
We marked that clip in the row called "Field preferences" since she seemed to bring the picture into the field identified by the interview, and in "Complexity," because she held it so close to her face, as she might have been blocking some of the background in order to see the two-dimensional image.

Sara:
Clip 3 shows Cassie during her hygiene routine. Cassie is sitting in front of a sunny window, where she does this routine. She seems to be drawn toward the light, but then has a squinting response. The light seems attractive but also unpleasant. Cassie is holding the toothpaste tube and shakes it in front of her own face. We noticed that the toothpaste tube had a striped pattern on it with a dark pink, a white, and an aqua stripe. A familiar song, "Quack quack" is playing. That song is a regular part of the hygiene routine: they actually refer to hygiene as "Quack quack." Let's watch the clip.

[video clip 3]

[music playing]

Sara:
We marked that one in "Color" because Cassie seemed to be drawn to the striped pattern. We also marked that in "Need for movement," since she shakes the tube while looking, and in "Light" because of her attraction to the bright light.

Lynne:
Clip 4 shows Cassie in the same area being attracted visually to the shadow of the blinds on the wall, which creates a striped pattern. She shows this interest by reaching for the shadow. Again she looks toward the light and then squints in response to it.

[video clip 4]

>>Teacher: Hi.

>>Cassie: Off? Off?

>>Teacher: [whispering] Off. We'll turn that off today. It's so bright. Ooooh, we are going to brush brush brush.

Lynne:
We marked that information in "Color" because again, she is interested in the stripes and in "Light" because again, she has the same response as in Clip 3.

In clip 5 Cassie picks up an item from a complex array. It is hard to tell if she is doing this visually or tactually. The item she chooses is a single color. She picks it up and moves it around while looking at it.

[video clip 5]

>>Teacher: Brush brush brush?

Lynne:
We marked this information in "Color" and "Complexity."

Sara:
In clip 6, Cassie picks up another single color item from the same array. This time the item has a texture on it that creates a striped pattern. Cassie studies this for a bit.

[video clip 6]

Sara:
We marked our ideas again in "Color" and "Complexity."

In clip 7, Cassie is exploring a light purple comb. She looks at it, then begins exploring it tactually, but as she does this, she seems to stop looking at it. Then she looks again briefly after she is done feeling the comb. The comb pattern also creates stripes. Cassie then seems alternately attracted to and repelled by the light reflecting from the metal "finished" basket.

[video clip 7]

>>Teacher: It was supposed to be on repeat.

>>Cassie: [laughs] Finished. Finished. Finished? And...

>>Teacher: It's finished.

Sara:
We marked that one in "Color" because it was an additional, single color item with stripes; in "Complexity" because the sensory environment competed with looking; and in "Light".

Lynne:
Clip 8 shows the sensory environment perhaps affecting Cassie's visually guided reach. She reaches towards a familiar item, her brush, on a non-complex background, the yellow sequence box. She looks away just before she makes contact with the brush. The music is also playing loudly.

[video clip 8]

>>Teacher: Good job! Brush your hair?

Lynne:
We marked these observations in "Complexity" and in "Visually Guided Reach."

Clip 9 happens at the end of the routine and the hygiene music is turned off. This is the first time Cassie looks at her teacher's face during this routine. Cassie looks away as soon as the teacher vocalizes.

[video clip 9]

>>Teacher: Quack quack off?

>>Cassie: Finished?

>>Teacher: Finished! Good job!

We marked that in "Complexity."

Sara:
In clip 10, we see Cassie looking very closely at Lynne's arm, which is moving while Lynne plays the accordion. The accordion is Cassie's favorite toy at school. Let's watch clip 10.

[video clip 10]

Sara:
We tried looking closely like Cassie did and found that the arm makes a big stripe, and thought that might be what Cassie was interested in. We marked this in "Color," and "Need for movement."

In clip 11, Cassie has left the area in which we were playing, then returns to ask for help getting on the swing. She find's my moving hand from about 15 feet, then pulls me over to request help.

[video clip 11]

Sara:
We marked that in "Need for Movement" and in "Distance Viewing."

Lynne:
Clip 12 shows Cassie's response to a striped pattern that I drew for her. The stripes are black and they are on white paper. Cassie's holds the item extremely close to her face. She opens her eyes wide and turns them up. She only examines the 2-d stripes briefly.

[video clip 12]

>>Cassie: One.

>>Teacher: Two. Three.

>>Cassie: Finished.

>>Teacher: Ok, thank you.

Lynne:
We marked this information in "Color" since there was some interest in the stripes; in "Field Preferences" because of where she places the item and holds her eyes; and in "Complexity" because she holds the item so close seemingly to block out the background. Also, once the talking starts, she lowers her eyelids and stops looking.

The next three clips are from a different observation of Cassie in the cafeteria, which is generally a very complex place. Cassie is able to use her vision surprisingly well in this environment.

Sara:
Clip 13 is very interesting. It shows Cassie on her way to the cafeteria. Cassie is able to navigate her route to the cafeteria, which is flat up until this point, but things break down on the stairs. Let's watch clip 13.

[video clip 13]

Teacher: Ooh! Two steps at a time! A daredevil!

Sara:
As you can see, Cassie basically closes her eyes and descends the stairs tactually. You can tell by the way she acts at the bottom of the stairs, reaching with her feet to see if there are more. She is getting information from her competing tactual sense in order to do this, so we marked this one in "Complexity." It also seems that stairs would be visually complex because they change as you move in relation to them. Even though you would think the stairs might look like a striped pattern, Cassie does not look at them. We also interpreted this as "Visually Guided Reach" because in this setting, Cassie is not able to look at and reach successfully with her feet to descend the stairs.

Lynne:
In clip 14, Cassie's teacher is asking her to pick up her milk. This is a noisy and visually complex environment, but Cassie is still able to find the milk carton, which is a complex, familiar, and favorite target. Also, her teacher draws Cassie's visual attention by moving the milk up to an easier to reach position and by moving her hand and tapping the milk, giving that movement to alert Cassie's visual system.

[video clip 14]

>>Teacher: There's the milk! Milk.

Lynne:
We marked the information in this clip in "Movement," "Complexity," and "Visually Guided Reach," noting that Cassie looked away just before she touched the milk carton.

Sara:
In clip 15, Cassie is able to look at her teacher's face in the noisy cafeteria just briefly. Then when her teacher makes a sound, it seems to be too much for Cassie, and she looks away.

[video clip 15]

[Teacher leans in and makes silly sound]

Sara:
We marked this observation in "Complexity."

Sara:
We asked Cassie's family and her educational team to answer questions about Cassie's visual behaviors. Cassie's mother, who answered the questions, was familiar with the characteristics of CVI. She gave us one set of answers and Cassie's educational team gave us another. Most of the time those answers agreed. We will consider both sets when recording our information. We'll skip over questions that don't contain information for us to record on our data sheet unless they seem to bring up something notable regarding vision. We recorded this information on the data sheet called "Interview Information." You can look at the parent interview guide on page 41 (Appendix 4.A) in Roman's book to help you interpret what CVI characteristics the questions are getting at.

Question 1 asks what they do to get Cassie interested in a toy or object. Her mother said music or lights catch her interest, and if there are none of those, she holds it in front of Cassie's face. School staff said they put it "in her field." We recorded those responses in the rows on the Interview sheet called "Light," and "Field Preferences."

Lynne:
Question 2 asks, "how you would know Cassie sees something when you show it to her?". Her mother said she grabs or reaches for it. School staff said that Cassie brings it to her face or moves it. They also said she looks out the window of the van when moving for the whole trip. We marked these items in "Need for Movement," Complexity," and "Distance Viewing."

Question 3 asks if Cassie has a favorite side or head position. Her mom said sometimes she tilts her head up. School staff agreed with this, and specified she does this when looking at faces. Also they said she walked with her eyelids partially closed and wondered if she was blocking some of the visual field. We marked this in the row called "Field Preferences."

Sara:
Question 4 asks if Cassie usually finds objects by seeing with her eyes or with her hands (meaning, feeling for them). Her mother said half and half, the school said, "Looking then touching." We marked that in the row called "Visually Guided Reach."

Question 6 asks where someone would hold something for Cassie to look at. Her mom said 1 ½ feet away and directly in front of her eyes, and that she wiggles it. The school staff said right in front-central. We recorded that information in the rows for "Distance viewing," "Need for Movement," and Field Preferences."

Lynne:
Question 8 asks what doctors have said about Cassie's eyes. Her mom said she has a little astigmatism in one eye, but that they are fine other than that. If we didn't already have the CVI diagnosis, the gap between how Cassie presents visually and that of another person with astigmatism in one eye would be a signal that the visual impairment must be in the brain.

Question 9 asks about when Cassie likes to look at things. The answer again identifies light emitting objects and moving objects that vibrate or wiggle. We marked this data in the rows "Need for movement" and "Light."

Sara:
Question 10 asks about Cassie's favorite color of things to look at. Neither thought there was a preference. We marked that data in the row for "Color."

Question 11 asks about what Cassie does near shiny and mirrored objects. Her mother said she is curious and if it's very shiny she will squint. The school said she is drawn to things that reflect a lot of light. We marked this in the row called "Light."

Question 12 asks about Cassie's response to lights or ceiling fans, and everyone said she likes to turn lights off and on. We marked that in "Light."

Lynne:
Question 14 asks about whether Cassie notices things that move or things that don't move first. Her mom said she notices things that move first. Her school said both because Cassie moves a lot. We marked this information in the row "Need for Movement."

Number 15 asks about Cassie's head positioning while she is looking at something. Her mom said she might slightly raise her head up. We marked this in "Field Preferences."

Number 16 asks again about favorite colors. Both school and home said they had not seen this. We marked this in "Color."

Sara:
Question 17 asks about Cassie noticing things in new places more, or in familiar places like home. Her mom said more in new places, but the school staff said she moves all the time in a new environment, and pays no attention to detail, which may seem like greater alertness depending on how the question is interpreted. We marked this in "Need for Movement," and in "Visual Novelty."

Question 18 asks about how Cassie holds her head when reaching toward something. Her mom said that she holds her head straight toward the object but sometimes turns away. We marked this one in the row called "Visually Guided Reach."

Question 19 asks how Cassie responds when given unfamiliar items to look at. Her mom said she shakes them and turns them around AND THEN looks at them. We marked that one in the rows "Need for Movement," "Visual Latency," and "Visual Novelty."

Lynne:
Question 22 asks what Cassie does when she has many items in front of her to look at. Her mom said she just takes one at a time and looks at them individually. School said they noticed she looks less. We marked this in "Complexity," for both of those, because "looking less" when there is a cluttered array is definitely a notable response, and even taking one item at a time could be a way to deal with the cluttered array, depending on how or where she holds the item.

Question 23 asks about Cassie looking at faces. Her mom said she looks at familiar people who she loves and trusts. School staff said she looks at everyone but doesn't seem to differentiate people by their face. We also marked that in "Complexity."

Question 25 asks about the visual characteristics of Cassie's favorite toys. Her mom said she likes things that light up. We marked that in the row called "Light."

Lynne:
Our phase II case study is a young lady named Cassie. Cassie has a diagnosis of CVI, secondary to anoxia, that happened during surgery when she was an infant. If she didn't already have the diagnosis of CVI, "anoxia" in her file would definitely be one of those red flags we talked about during the introduction. Intermittent nystagmus and slight hyperopia were also identified on her eye report. No glasses were prescribed. Her acuities were identified as 20/200.

Sara:
Cassie also has an auditory processing disorder and is labeled deafblind. She uses an object calendar and her team would like to transition her to pictures. They are also considering introducing a few simple signs in American Sign Language.

Lynne:
She enjoys interacting with adults and sometimes has difficulty with transitions. Cassie laughs when people make funny noises, like sneezes or burps. She is able to say a few short phrases, such as "Sit Down," "Stand up" and "Finished" but, people may find her difficult to understand. She is also able to say her own name. She communicates more specific needs to adults by pulling them or hand guiding them to specific things to request assistance.

Sara:
The Ratings in the CVI Range have uses that may be important to teachers of the visually impaired or others who are considering CVI assessment results and how they affect educational programming. Rating I can be used to determine present levels of visual functioning and Rating II can be used to determine modifications or adaptations for the Individual Education Plan. These two sets of information are important when writing a functional vision evaluation and learning media assessment, and can make up the bulk of the CVI narrative, if done separately.

Lynne:
The plus statements in Rating I of the CVI Range can be used to determine present levels of visual functioning. For Brandon, the plus statements are the following:

Prolonged periods of latency in visual tasks: demonstrates a delay in directing vision to a target every time or nearly every time a new object is presented or a new activity begins.

No regard of the human face: no attention to human faces, may seem to "look through" people.

Visually fixates when environment is controlled: intermittent eye-to-object contact, but only when visual, auditory, and tactile distractors are reduced or eliminated. A small degree of additional sensory input may be tolerated while viewing.

Less attracted to lights; can be redirected: may stare at lights, but is able to shift attention from lights when appropriate visual targets are presented in controlled environments.

Has a "favorite" color: continues to most consistently glance toward or have eye-to-object contact with targets made of a single, preferred color (red, sometimes blue) over objects of all other colors.

May notice moving objects at 2 to 3 feet: glances toward or has eye-to object contact with objects that move in space or are made of shiny or reflective materials and are at distances up to 3 feet.

Selection of toys or objects is less restricted: requires one to two sessions of "warm up:" looks at new objects that have attributes of familiar objects. Recognizes new objects immediately after one to two presentations.

Sara:
The numbers on Rating II, or the highlighted areas of the CVI Resolution Chart, can be used as a helpful guide for describing appropriate modifications for your student.

Here are some accommodations that can be included in the IEP:

Number one: Brandon is more drawn to red objects. Also blue and green objects to a lesser degree. Use these colors as a visual anchor. Items that are one single color will draw his visual attention the best at this point. Colors that did not seem to draw visual attention included yellow. Yellow is typically used with students with CVI, but would not be indicated for Brandon.

Number two: Use reflective/shiny materials to draw Brandon's visual attention. Movement draws his visual attention but may not sustain it, so once he has begun looking, stop moving the object. Learning environments in which Brandon can easily move items himself may help him to understand movement and what his brain is perceiving through his eyes along with other sensory characteristics of an object.

Number three: Use objects consistently within routines that are a single, favored color, especially red, or use objects with reflective properties. Give Brandon extended time to "see" objects that are novel or multi-colored, or are non-favored colors.

Number four: Present instructional items in Brandon's central left field. Items that have reflective, movement, or light qualities can also be presented in his peripheral fields, as long as it can be detected by Brandon with his left eye.

Lynne:

Number five: When expecting Brandon to use his vision, keep environmental sounds and tactile input to a minimum. Use objects that are a single color unless they are backlit. Instructional materials should be three dimensional, in that a picture of a plate Brandon uses at lunch would not be recognizable as a lunch symbol, but the actual plate he uses would be appropriate. Also, use hand-under-hand as opposed to hand-over hand when showing or guiding Brandon. This allows him to regulate the amount of tactile input he is receiving.

Number six addresses Brandon's response to Light: Moderate levels of light can be used to attract Brandon's visual attention to functional objects.

Sara:

Number seven addresses distance and has many implications. Brandon can detect moving items that are slightly beyond his near space, and this may be used for travel, for example, a shiny, reflective landmark may be used to denote a frequented location. Instructional materials should be within arms reach, especially if they are not moving. Allow Brandon to lean in close to view items of interest. Encourage Brandon to look while traveling by providing opportunities to access a non-complex sensory environment during these times, for example, travel the hallways right before or right after a passing period, instead of during.

Number eight: When presenting novel objects, consider using ones that have characteristics such as movement/reflective qualities and preferred color. Build items Brandon can recognize immediately by using consistent materials in multiple routines.

Lynne:

Brandon's ability to look and touch simultaneously is still developing. Brandon should have plenty of opportunities to act on the objects in his environment that he can best see, using the above accommodations. Functional routines that encourage Brandon to interact with his hands and his eyes at the same time, such as eating, hygiene, etc, can give him frequent practice at integrating sensory information.

Sara:
The CVI Resolution Chart can be a quick reference guide to use when developing the IEP to accommodate and support a student's current visual functioning. Following the directions at the bottom of the chart, we will draw an "X" through boxes that represent resolved visual behaviors, use a highlighter to outline boxes describing current visual functioning, and draw an "O" or circle in boxes that describe visual skills that may never resolve due to coexisting ocular conditions. The boxes highlighted correspond with the scores given on Rating II of the CVI Range.

For Brandon's CVI Resolution Chart, in the first row, "Color," we would draw an "X" through the first box, since Brandon is able to look at items that are red, blue, pink, and sometimes responds to green and even multicolored items. The next box, "Has 'favorite' color," is the one we highlighted to describe Brandon's visual behavior. Highlighting the next box seemed too big a jump. Due to Brandon's coexisting ocular condition of optic nerve atrophy, he may have difficulties with color vision, so this may not resolve. We drew a circle in Ranges 5 to 6, 7 to 8, and 9 to 10.

Lynne:
In the second row, "Need for movement," we put an "X" in the first box, since Brandon was able to look at some objects that did not have movement or reflective properties. The second box, "More consistent localizations, brief fixations on movement and reflective materials," seemed to describe Brandon's visual functioning the best, so we highlighted that box.

In the third row, "Visual latency," we highlighted the first box, Range 1 to 2, since Brandon continues to need extra time to respond to a variety of items. This seemed to best describe his visual behavior: Brandon was able to look more quickly at favorite items in familiar routines as well as novel red items, backlit or spotlighted items, and shiny, reflective items.

Sara:
The fourth, "Visual field preferences," presented one of those situations in which, due to retinal detachment in the right eye, the characteristic will not resolve. We highlighted the first box, Range 1 to 2, "Distinct field dependency." We drew an "O" in all the rest of the boxes in this row. Also, due to optic nerve atrophy, Brandon may never be able to use his peripheral vision as well in his left eye.

In the fifth row, "Difficulties with visual complexity," we put an "X" through the description in the first column, Range 1 to 2, since Brandon, though he is generally distracted by any other sensory input, he does occasionally continue to use his vision with slight environmental noise. The next box, Range 3 to 4, was the one we highlighted.

Lynne:
In the sixth row, "Light-gazing and nonpurposeful gaze," we put an "X" through the first column because we saw Brandon looking at objects, though not faces, for longer than brief periods, and because he is somewhat distracted by or attentive to lights, but it is not a huge problem. We marked Range 3 to 4 with a highlighter because Brandon can be redirected to targets that are not light sources.

In row seven, "Difficulty with distance viewing," we put an "X" in the first box because Brandon noticed items that were beyond his near space, though most items were still very close and he leaned in to get even closer for a better view. Column 2 was highlighted since Brandon noticed some things that were large or moving from a little ways off. We drew a circle in the rest of the boxes because, due to the blurred vision/reduced acuity that accompanies optic nerve atrophy, Brandon's distance vision may be affected and not resolve.

Sara:
In the eighth row, "Atypical visual reflexes" we put an "X" in the first column because Brandon did blink in response to being touched at the bridge of his nose. He did not blink when presented with a visual threat, so he definitely is not functioning in the third box. We highlighted the second box, "Blinks in response to touch, but response may be latent," since it seemed to best describe Brandon's visual behavior.

In the ninth row, "Difficulty with visual novelty," we noticed that Brandon was able to look at new items fairly quickly, especially if they had attributes of familiar items or were of a favored color. Certain items he took longer to look at, but these neither resembled anything we saw him responding to in familiar routines nor were they similar to items mentioned in the interview. He was able to look at unfamiliar items without first looking at familiar items. We highlighted the fourth column, "Selection of objects less restricted, one to two sessions of "warm up" time required."

Lynne:
In the tenth row, "Absence of visually guided reach," we put "Xs" in the first and second boxes, since we did observe Brandon looking and touching at the same time in certain circumstances, and highlighted the third box, "Visually guided reach used with familiar objects or 'favorite' color" since we saw him looking and touching simultaneously with novel red items and with his familiar blue button. Also, his parents reported that Brandon positions his head straight while reaching. We assumed that items at home are pretty familiar.

Lynne:
So now we're going to look at the forms in the back of Christine Roman's book. 2 pages after page 185 starts the "Essential Forms" section. Look at the first form, which is called "The CVI Range: The Across-CVI Characteristics Assessment Method", or "Rating 1". We'll compare the notes we've taken from all of our information sources including the interview, the observation, and the direct assessment to the "CVI Range Scoring Guide" which is in the book on page 97, or appendix 5.A.

Sara:
The first statement in the first section, "CVI Range 1 to 2: Student functions with minimal visual response," is "May localize, but no appropriate fixations on objects or faces." We looked at our data sheets in the rows mentioned in the column on the Scoring Guide called "CVI Characteristic." Those were color, movement, latency, visual fields, complexity, and novelty. We found information from the interview and from the observation supporting that the description under the plus-minus column best describes Brandon. That is, He "gives brief, inconsistent attention toward an object or face."

Lynne:
The second statement is "Consistently attentive to lights or perhaps ceiling fans." We found information in the areas of movement, complexity, and light-gazing on our data sheets that best characterizes Brandon's behavior in the column plus-minus from all the data sheets: This says, "Occasionally able to attend to non-lighted targets, even in the presence of primary sources of light."

In the third statement, "Prolonged periods of latency in visual tasks," we found our data matched the plus column, which says "Demonstrates a delay in directing vision to a target every time or nearly every time a new object is presented or a new activity begins." We found that information from the observation and from the direct assessment data sheets in the latency row.

Sara:
The fourth statement, "Responds only in strictly controlled environments," we found to be more of a plus-minus, in that Brandon has "occasional attention to visual targets in the presence of certain or familiar visual, auditory, or tactile distractions." We found that kind of data in the complexity section of all of our data sheets.

The fifth statement, "Objects viewed are a single color," we found to also be a plus-minus because Brandon "Glances at or briefly fixates on objects of [his] favorite color and occasionally on objects of other colors," and because he "May also glance at or briefly fixate on objects that have more than a single color." We looked in the sections on color, complexity, and novelty, as suggested by the Scoring Guide and found support on all of our data sheets for this.

Lynne:
With the sixth statement, "Objects viewed have movement and/or shiny or reflective properties," the statement that seemed to fit Brandon the best was again the plus-minus, in that Brandon seems to "...need movement and/or shiny or reflective objects to initiate visual attention." He also "occasionally attends to objects without movement properties." Information from the interview and direct assessment data sheets confirmed this in the area of movement.

Statement seven, "Visually attends in near space only," was best defined by the plus-minus option when looking at Complexity and Distance viewing from all areas of the data, because Brandon "Occasionally glances at or fixates on objects beyond 18 inches."

Sara:
The eighth statement, "No blink in response to touch or visual threat," posed difficulty because we hadn't yet tested that, so we asked Brandon's classroom teacher, who is a teacher of the visually impaired, to test Brandon's blink response. He said that Brandon blinked consistently in response to being touched at the bridge of the nose, but not when an object was coming toward his face. We marked this in the column that was closest to that information: "Occasionally blinks in response to touch or threat." We counted that as part of the direct assessment.

The variation of the ninth statement, "No regard of the human face," that we found best described Brandon was the plus, or "No attention to human faces, may seem to 'look through' people." We found this from the interview section on complexity. We also noticed that Brandon did not look at people's faces throughout our interactions with him, but we did not mark it on any data collection sheet, we just made a mental note of it. This was a more global observation.

Lynne:
The second section, "CVI Range 3 to 4: Student functions with more consistent visual response," begins with "Visually Fixates when the environment is controlled." We found the plus statement in the CVI Range Scoring Guide, "Intermittent eye-to-object contact, but only when visual, auditory, and tactile distractors are reduced or eliminated," was true for Brandon from looking at the complexity section of the observation and direct assessment data sheets. The statement, "A small degree of additional sensory input may be tolerated while viewing," was true at times as well.

The second statement in this section, "Less attracted to lights; can be redirected," we found to be true in the plus column when looking at light gazing in the observation and direct assessment data. Brandon "may stare at lights, but is able to shift attention from lights when appropriate visual targets are presented in controlled environments."

Sara:
The third statement in this section, "Latency slightly decreases after periods of consistent viewing," seemed more true in the plus-minus column. We noticed, through the observation and direct assessment data in the area of latency, that the statement, "Delay in directing vision toward a target occurs frequently, but not every time a familiar target is presented," was the one that best matched the data we took.

The fourth statement, "May look at novel objects if they share characteristics of familiar objects," we found to be resolved. Many novel objects were presented in the direct assessment, and we had to take that into consideration. The ones Brandon was able to look at most quickly shared characteristics of familiar items, were one color as opposed to multi-colored, and were his favorite color. He was definitely able to look at unfamiliar items, sometimes only by glancing. Sometimes he looked for a bit longer. Not all seemed to resemble favorite or familiar items. We found that to be the case from the overall direct assessment, but not so much from single pieces of data.

Lynne:
The fifth statement is, "Blinks in response to touch and/or visual threat, but the responses may be latent or inconsistent." We found the variation in the plus-minus column to describe Brandon, "blinks to touch, but not to a target moving quickly toward the face," from what the teacher told us, which we counted as direct assessment.

The next statement, "Has a 'favorite' color," had a description in the plus column that seemed to match the data on color from all our collection sheets. Red seems to be Brandon's favorite color. The plus column states, "Continues to most consistently glance toward or have eye-to-object contact with targets made of a single, preferred color, over objects of all other colors."

Sara:
The sixth statement, "Shows strong field preferences," needs to be considered in that this is an ocular condition and cannot be resolved in the brain. The minus column best described Brandon's data from all sources, "Glances toward or has eye-to-object contact in one viewing field only."

The seventh statement is "May notice moving objects at 2 to 3 feet." We found this to be in the plus column from the interview and observation data on movement and complexity, and that Brandon "Glances toward or has eye-to-object contact with objects that move in space or are made of shiny or reflective materials and are at distances up to 3 feet."

Lynne:
The next statement, "Look and touch completed as separate events," seemed to ring true for Brandon in the plus-minus column from looking at visually guided reach in the observation and the direct assessment. Brandon "Occasionally uses visually guided reach."

We found all of the statements to fall in the minus category except the following in the next section, "CVI Range 5 to 6, Phase II: Student uses vision for functional tasks."

Sara:
The first statement, from information on color and complexity in the direct assessment, "Objects viewed may have two to three colors," seemed to fall more in the plus-minus column for Brandon: "Looks directly at targets that have two and occasionally three colors, preferred color is always one of the colors."

The second statement, "Light is no longer a distractor," applies to Brandon more in the plus-minus column again: we saw Brandon "Occasionally gazing at primary sources of light," during the observation and direct assessment and it was found in the section on light on the data sheets.

The third and fourth statements are minuses.

Lynne:
The fifth statement is "Student tolerates low levels of background noise." The plus-minus column described what we saw in Brandon, in that he "Occasionally is able to maintain visual attention in the presence of sound." We saw this from the observation and from the direct assessment in the area of complexity.

The sixth statement is "Blink response to touch is consistently present." We found that the plus-minus statement, "Emerging pattern of blink-to-touch response present," was the best description of Brandon's behavior, since his teacher said his blink to touch was consistent, but delayed.

The rest in this section were minuses.

Sara:
In the section on "CVI Range 7 to 8, Phase III: Student demonstrates visual curiosity," we marked three that were not minuses. The first one was the first statement, "Selection of toys or objects is less restricted; requires one or two sessions of 'warm up.'" The statement under the plus column, "Looks at new objects that have attributes of familiar objects: recognizes new object immediately after one to two presentations," seemed to best describe Brandon's visual behavior. We looked in the complexity and novelty rows of our data sheets and found information that supported this in the observation and direct assessment.

The second one was the second statement, "Competing auditory stimuli tolerated during periods of viewing; the student may now maintain visual attention on objects that produce music." In the column plus-minus, the statement "Occasionally is able to maintain visual attention while other sensory input competes," is true in the very occasional sense. We found this supporting data in the observation and direct assessments under complexity.

Lynne:
The third one, in the fourth statement "Latency rarely present," the plus-minus seemed to describe Brandon best: "Novel objects, complex environments, or fatigue may increase degree of delayed response." We saw Brandon's looking behaviors decrease after 10 to15 minutes of asking him to look at items. We found this in the direct and observation data in the area of latency.

All of the rest of Rating I were minuses.

On page 61 of "Cortical Visual Impairment" Roman writes "The individual statements that describe visual behaviors are matched to the child's visual responses and scored until a 'ceiling effect' has been reached. A ceiling effect occurs when the pluses that indicate the student's current level of functioning end, and a cluster of minuses occur for four or more consecutive items. The minuses indicate that the student has not yet reached the level of functioning described in that range. The student's score of the assessment is determined by the number of the CVI Range in which the last plus item occurs prior to the shift to scores of plus/minus and minus. Since each group of statements is identified by a range of two scores, the lower number of the range is assigned if the plus statements end in the middle of the cluster, the higher number is used if the plus-scored statements are marked to the end of the cluster."

Sara:
We had five plusses in Range 3 to 4 before scores turned to all plus/minus and minus, and they were dispersed throughout the cluster, so that would make Brandon's score for Rating I a four, which can be recorded on the front page.

The next section is called Rating II, the "Within-CVI Characteristics Method." The numbers stand for "not resolved" at 0, and in increments of .25, stand for various levels of resolution up to 1, which means "Resolved." These numbers correspond with numbers on the top row of the CVI Resolution Chart. The CVI Resolution Chart can be found at the end of the book within the forms in the same section as the CVI Range Ratings I and II. Rating II can be completed by matching the level of resolution described on the Resolution Chart of each characteristic that best depicts the child. Each characteristic is given a number, and after that, the numbers are added up to find a value for Rating II.

Lynne:
For number 1 Color preference, we noticed that Brandon is able to look at many different single colored items, not only red. He also showed interest in several items or patterns that had more than one color in limited situations. We scored him with a point two five, Range 3 to 4.

For number 2, Need for movement, we noticed that Brandon was able to look at some items that did not have movement properties, especially if they were lighted or light was shined upon them. We scored this characteristic with point two five, Range 3 to 4.

Sara:
For number 3, Visual latency, Brandon really was able to look fairly quickly at some items, even novel ones, but some items still had longer periods of latency. This was more prevalent when he was tired, but sometimes it happened at the beginning of a testing session as well. We scored this characteristic as .25, or Range 3 to 4.

For number 4, Visual field preferences, Brandon showed a distinct field dependency. This is not surprising since he has a detached retina on one side. This is not something that will be resolved. We scored this as a 0, or Range 1 to 2.

Lynne:
For number 5, Difficulty with visual complexity, Brandon was able to occasionally tolerate some level of noise while looking, especially if the visual target emitted light. He does not look at faces, not even familiar ones, at this point. We marked this characteristic at point two five, Range 3-4.

For number 6, Light-gazing and nonpurposeful gaze, we saw Brandon being able to look away from primary sources of light when engaged in activities, but he was definitely still distracted by light. We marked point two five in this characteristic, Range 3 to 4.

For number 7, Difficulty with distance viewing, the CVI Resolution chart's description of Range 3 to 4, or point two five, perfectly describes Brandon's visual behavior, so that is where we marked this characteristic.

Sara:
Number 8, Atypical visual reflexes, was tested by his classroom teacher, who is also a Teacher of the Visually Impaired. It was reported that Brandon did have a blink response to touch, but that he did not have a blink to threat response yet. This leaves .25, Range 3 to 4, as the most appropriate place to score this characteristic.

Number 9, Difficulty with visual novelty, was interesting because most items that Brandon looked at during our observation of his routines, and some that he didn't look at, were familiar and a single color. All items that were presented during direct assessment, except a few patterns, shared similar characteristic of familiar items in that they were a single color, and many were the same color as items Brandon had been observed looking at, or had been reported as favorite colors. Complexity seemed to be more of the interfering factor than novelty. We marked this characteristic as .75, or Range 7-8.

Lynne:
Number 10, Absence of visually guided reach, was scored at .5, Range 5 to 6 because Brandon was definitely able to use visually guided reach, difficult as it might be due to looking with his left eye and reaching with his right hand, within a familiar routine with a familiar, single color visual target. He also reached toward shiny and red items without looking away.

So all ten scores, .25, .25, .25, 0, .25, .25, .25, .25 .75, .5, added together equals 3. This can be recorded on the front page for Rating II. The CVI Range is between what was found for Rating I and Rating II. Brandon's CVI range, then, we found to be 3 to 4 with a difference of 1. If you refer to the very top of the CVI Resolution Chart, Brandon would be functioning at a high Phase I, Building Visual Behavior, and at a low Phase II, Integrating vision with Function.

Lynne:
When we assessed Brandon, we did it in several short sessions. Looking seemed to be hard for Brandon and we didn't want to tire him out too much. We assessed him on three different occasions: in his darkened classroom with no other students present, in a room with low light, and then back in the darkened classroom room using an APH light box. The darkened room helped reduce the complexity of the visual environment. Darkening the room might help in assessment of students who seem to be functioning in Phase 1. Teachers may use it as an adaptation if it is found to help significantly.

We recorded our thoughts on the data collection form called "Direct Assessment Information."

During the first dark room session, we often shined a light on objects if Brandon did not seem to notice them. Since he is interested in buttons and switches, you may notice that turning off and on the light switch can be very distracting to him. The light source itself was sometimes distracting when it was held so that Brandon could detect it within his visual field.

Sara:
In clip 1, Brandon responds to a lighted red plate. He locates it rather quickly, then looks away, then when prompted touches it while looking at it. Let's watch the first clip of the direct assessments.

[video clip 1]

>>Brandon: Um-hum.

>>Teacher: Uh-huh. You can touch it if you want to. Um hum. Permission.

Sara:
We gathered a wealth of information in that short clip, and we recorded it in the rows on the part of the data sheet in "Color," because it was red, "Visual Latency," because he looked fairly quickly, and "Complexity" because the room was quiet and with the lights being out, had little competing visual input. We also recorded information in "Distance," because the object was presented very near to Brandon, and in "Visually Guided Reach" because he reached toward the favored color item without looking away.

In clip 2, Brandon responds to a lighted blue item. He glances at it, then looks away before touching it, and then leans in very close to look at it again, which he sustains until construction vehicles outside distract him with a beeping sound.

[video clip 2]

>>Teacher: Um-hum. Pretty cool! Good job.

>>Brandon: Eep. Eep.

>>Teacher: Hum?

>>Brandon: Eep.

>>Teacher: Oh, you hear that beeping?

Sara:
We marked the information from this clip in the row for "Color," since the blue, single color object draws his attention, but not as much as the red one. We also marked "Visual Latency" because his response is not immediate like with the red item, "Complexity" because the beeping noise caused him to look away, "Distance," because he positioned himself so close to the object, and "Visually Guided Reach," since he was unable to look and touch the unfamiliar blue item.

Lynne:
In clip 3, Brandon is leaning in to look at the shiny gold item and then stops looking. When the flashlight is clicked on, he directs his gaze to the sound source and looks for a long time at the light source. Then he is able to look away from the light source and look at the lighted, shiny gold item and reach for it simultaneously.

[video clip 3]

>>Brandon: Uh-oh out.

>>Teacher: [laughs]

Lynne:
We marked that on our data collection sheet in several places. We put it under "Need for Movement" because the item was shiny and drew Brandon's visual attention even before the light was shined on it. We put it under "Light," because Brandon looked at the light source for quite a while, "Distance," because Brandon positioned himself so close to the target, and "Visually Guided Reach" because he was able to reach without looking away.

Clip 4 involves a silver and blue shiny pinwheel with a light shined on it- Brandon is able to look at it. It is presented more centrally at first, before the video clip starts, then it's moved to the left. Brandon has trouble locating the new position with his hand. This may be due to increased complexity, with 2 colors in the pinwheel along with increased teacher noise.

[video clip 4]

>>Teacher: Wanna touch it one more time?

>>Brandon: Yeah.

>>Teacher: Oops, where'd it go? It moved.

>>Brandon: Sorry.

>>Teacher: No, it's quite allright. It moved. Uh-huh. Now see if you can touch it. Good! Very good!

Lynne:
We marked this in "Color," because the item has 2 colors, "Movement," because the item is shiny, "Complexity," because Brandon was unable to act on the object the same way as the shiny gold item and there was increased environmental noise and increased complexity of the target, "Distance Viewing" because he leaned in to look, and "Visually Guided Reach" because he was unable to look and touch at the same time.

Sara:
In Clip 5, Brandon is shown a shiny aluminum pie pan, which basically acts as a light source. The shiny, reflective factor gives that supercharged movement effect. He is unable to reach for and look at the item at the same time, and he also may be tired: it's about 13 minutes into the session. Also, there is a low-level background whistling noise.

[video clip 5]

>>Teacher: Wanna see if you can touch that thing? Um-hum, that's my arm. Yeah, very good! Yeah? You got close. Try one more time. Um-hum you got my arm. You got so close. That's it. Tap it? [laughs]

Sara:
So we marked this information in "Movement," "Visual Latency," "Complexity," "Light," and "Visually Guided Reach."

Clip 6 is the last in the first session. Brandon is being shown a black and white dog with a pink tongue, which is being wiggled on his left side and has light shining on it. He glances at it and then looks away and reaches for it. The toy is activated to make a sound and following that all visual behavior stops.

[video clip 6]

>>Teacher: Um-hum. Oh, you saw that.

>>Brandon: Hug.

>>Teacher: Um-hum. You can have some hugs and kisses in just a minute. [laughter] Ready? [activates toy]

>>Brandon: Sorry.

>>Teacher: You're doing great! [activates toy] Woah! [laughter] Scary dog. Wanna look at it with your eyes? Uh-hum, you touched it. Dog bite.

>>Brandon: [laughs]

Sara:
We marked this one in "Visual Latency" because he visually detected the novel object, but did not fixate. It is also the end of the session and he may be fatigued. We also marked "Complexity," because auditory input stopped his looking behavior, and in "Visually Guided Reach" because he looks away while reaching before all the looking stops.

Lynne:
The next session involves a relatively non-complex visual environment (plain walls, no shelves, etc.) and low light. At the beginning of the session Brandon is distracted by the other students talking, but then they leave and the area is fairly quiet. Items are presented in front of an invisiboard.

Clip 7 shows Brandon's response to a flashlight with a red filter shined toward him in his upper peripheral left field, lower peripheral left field, and lower central field. He seems to respond to the second two. He is also tested on his right side but no response is observed, as expected, since Brandon has a detached retina on that side. He is paying a great deal of attention to background noise during this clip. In the very last part, he seems to look longer toward the red light source. Environmental noise has been greatly reduced by this time.

[video clip 7]

>>Teacher 1: He noticed that.

>>Teacher 2: Um-hum.

[Background noise:other students talking]

>>Teacher 1: Not that one so much. I'll try this side anyway. I know it's...it's not so good.

>>Brandon: Um-hum.

Lynne:
We recorded this information in "Color," "Field Preferences," and "Complexity."

Sara:
In clip 8, Brandon is shown a pink moving item, and seems to notice and really look for a few seconds once a light is shined on it. The item is presented for about 90 seconds before Brandon looks at it, but only the end is shown in the clip.

[video clip 8]

>>Brandon: Ha ha ha.

>>Teacher: Hee hee hee.

>>Brandon: Hi. Hi!

>>Teacher: I'm going to count that as a notice.

Sara:
We recorded the information from clip 8 in "Color," because pink does not seem to be preferred, though it is a single color and does draw a small amount of visual attention. We wrote our notes in "Visual Latency," because it takes him a long time to look, and in "Complexity" because the environment had to be extremely controlled in order for Brandon to see this item.

In clip 9, Brandon is again presented with the aluminum pie pan, which he seems to notice immediately, even before the light was shined on it: it is shiny and also produces movement. He also maintained visual attention, but this may have been because it looked like a light.

[video clip 9]

Sara:
We recorded the information from this clip in "Need for Movement", in "Complexity" since the environment was well controlled, and in "Light."

Lynne:
Clip 10 is interesting because Brandon is being asked to look at vertically hanging gold beads. This may be the smallest visual target we asked him to look at. This is the last clip of the second testing session- we have been testing about 10 minutes. It takes him about 5 seconds to look at the shiny, moving gold beads. The beads also act as a sort of vertical stripe, which is the first evidence we see that may indicate a pattern preference of Brandon's.

[video clip 10]

Lynne:
We recorded this data in the rows for "Color," in that this is a vertical stripe and a pattern, in "Movement," and in "Visual Latency."

The next testing session was done in the dark familiar room with the light box. At times there are low levels of background noise. All of these clips should be considered when thinking about Brandon's response to light, though we don't necessarily identify each of them this way.

Sara:
In clip 11, we see Brandon noticing the light box with the red filter, turning his head away, then turning his head back. He then lowers his eyelids and turns away as soon as he hears the door closing.

[video clip 11]

Brandon: Oh, sorry. Psssst.

Sara:
We marked this on the data collection sheet in the rows for "Color" and "Complexity."

Clip 12 is interesting because the movement of the hypnodisc, for lack of a better term, on the red filter seems to draw Brandon's visual attention, but when the disc is still, he looks until it begins moving again. It's like movement draws his attention but then it has to stop in order for him to keep looking.

[video clip 12]

>>Brandon: Um-hum. [chuckles] Alright.

Sara:
We marked these observations in the rows "Color" because the hypnodisc seemed to be a pattern that Brandon liked, and in "Need for Movement," because of the way the movement attracted Brandon's visual attention and then made him look away.

Lynne:
In Clip 13, a disc is presented with very small dots. Brandon does not seem to be responding to the small dots: he tries briefly to get a closer look, but this pattern does not seem very detectable to him.

[video clip 13]

>>Teacher: This one's not as interesting.

Lynne:
We marked this in "Color," since this pattern did not seem to be preferred.

Clip 14 illustrates that Brandon does indeed prefer red to green, as you see him looking much less at the green filter on the lightbox, with or without the hypnodisc.

[video clip 14]

>>Brandon: Hi.

Lynne:
We marked this observation in "Color" on the data sheet.

Sara:
In Clip 15, We see Brandon looking for a sustained amount of time at the hypnodisc when it is still, but when it begins to move, he looks away.

[video Clip 15]

>>Brandon: Um-hum. Alright.

Sara:
We marked this in "Color" because, again, he was attracted to this pattern, and in "Need for Movement," because he looked away when it began to move.

In clip 16, Brandon is presented with much larger dots made of white light. He examines these briefly. Brandon is then presented with a zig-zag pattern, first with no filter, and then with the red filter. Brandon seems to have little interest in this pattern.

[video clip 16]

Brandon: [inaudible] Eat? Aw, man!

Sara:
We marked observations about these patterns in the row "Color."

Lynne:
In Clip 17, Brandon turns toward the lightbox in front of him with no filters or patterns on it. He squints and turns away from it.

[video clip 17]

>>Teacher: Wow, bright, huh?

Lynne:
We marked this observation on the data collection sheet in the row called "Light."

Clip 18 is interesting because this seems to be one of the most complex items that Brandon is asked to look at. It is a multi-colored vertically striped pattern. He seems to be interested, even with background noise, but can't look for very long. This pattern contains Brandon's favorite color, red, and his second favorite, blue.

[video clip 18]

[background conversation]

Lynne:
We marked this information in "Color" because of the large number of colors Brandon seems to be seeing even this late in the testing session, and because of the vertical stripe pattern, which seems to be something that is easier to look at. We also marked this in "Complexity" because of the complexity of the target and the environmental noise competing.

Sara:
In Clip 19, the final clip of this testing session, Brandon is asked to look at a checkerboard pattern on various colors, and we'll see that he looks the longest when it is on the red, confirming that red is a nice anchor color for Brandon. He is also able to look with other filters, just not for as long.

[video clip 19]

>>Brandon: Hi. Um-hum.

>>Teacher: Green, huh? Allright. Swirly mat time. What do you think, Eric? What do you think we need?

Sara:
We marked this information in "Color," because the checkerboard pattern always seemed to draw his attention, even after having been requested to look for so many turns, and because red remains the most attractive color for looking.