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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.

Sara:
Now we'll look at video clips of Brandon in his classroom environment participating in regular routines. We tried not to interfere so that this would be a good example of a normal day, even though, unavoidably, our presence was sometimes distracting to Brandon. We recorded our interpretations about visual behaviors on the part of the data collection sheet called "Observation Information."

In the first clip Brandon is playing the keyboard and looking at the overhead lights. There is a small amount of environmental noise and some noise that he is making with the keyboard. Let's watch the clip.

[video clip 1]

Sara:
We marked this in the row called "Complexity" because Brandon does not look at what he is doing/touching at this time, and in the row called "Light" since he is gazing at a light.

Lynne:
In the second clip, Brandon's teacher is engaging him in a familiar, enjoyable routine with a yellow whoopee cushion. The cushion is placed in the periphery on Brandon's left side, which is the side Brandon reportedly uses for viewing, and he seems to look at it, though he is very surprised when the cushion makes a noise. There is also the tactile input that it gives him. All this interrupts his viewing and he immediately looks away. He may have needed more time to look so that he could process the whoopee cushion visually. He did seem to look at it again briefly right before he added keyboard noises to the game. Yellow doesn't appear to be the best visual anchor for him in this instance.

[video clip 2]

>>Brandon: Mmmmmmmm... [startles at sound of whoopee cushion]

>>Teacher: Oh my goodness, I'm sorry, I totally...[begins to squeeze whoopee cushion rhythmically]

>>Brandon: [begins to vocalize in response to whoopee noises, then plays keyboard rhythmically.]

[laughter]

Lynne:
This clip gave us a lot of information, which we marked in the rows called "Color," "Visual Latency," and "Complexity."

In clip 3, Brandon is doing something very motorically difficult, which is walking in the hallway with his walker. This is a familiar routine surrounding a favored item, a blue button that Brandon likes to push. He is motivated to do the hard work of walking for it. Brandon's teacher is playing a silly game with him by giving him the auditory input, but as an experiment we asked her to nix the game for a bit to see if Brandon was able to look more. We see that he uses his vision more frequently when verbal play is not competing. During the play he looks up one time in 12 seconds, but during the silence he looks up three times in 16 seconds. During the silence, he also says, "Hi" to the teacher who is walking backwards in front of him, who is about 3 feet away.

[video clip 3]

>> Teacher: Left, left, left right left. Uh-oh, we're gonna scrape up against the wall unless we change course.

>>Brandon: Hi.

Lynne:
We marked the information from clip 3 in the rows "Complexity" and "Distance."

Sara:
In clip 4, we see Brandon at the button with his right side near it so that he can reach it, since he uses his right hand much more than his left. His teacher uses hand-under-hand guidance to support his hand use. She also provides him with physical support so that he can focus on moving his body and not worry about falling. Brandon has to turn his head to locate the familiar blue button using his left eye, which he does several times before he can act on the button. All this requires a great deal of motor planning and serves as competing tactile input. Again we see Brandon's looking behavior increase when the teacher pauses in her verbal play. The visual background is very plain: The wall is plain and off-white and the button stands out from the background.

[video clip 4]

>>Brandon: Button?

>>Teacher: Yes that's where we are: we're at the button and all you gotta do is reach out. You're totally gonna find it. I got you. I got you. You are not going to fall. You're gonna reach. Hey. There you go. Let's get you started a little. Ohhhh: it's exciting!

Sara:
We marked the information from this clip in "Color," "Visual Latency," "Field Preferences," and "Visual Novelty."

In clip 5, Brandon is able to fixate on the blue button for some time, even while the teacher is talking and even when he is reaching out to touch and push the button. When the button activates the door it makes a sound and gives the tactile input of the wind blowing in from outside, and Brandon looks away.

[video clip 5]

>>Teacher: Oh, want you to use that hand. Nice job, go ahead and push that button. Push push push. Give it a push. Nice! Oh, feel that cold air!

Sara:
We marked this information in "Field Preferences," "Complexity," "Visual Novelty," and "Visually Guided Reach."

Lynne:
We asked Brandon's team of educators and his foster family to give us information regarding Brandon's visual behaviors. At that time, Brandon's foster family did not know him nearly as well, so they were unsure of how to answer some of the questions. They did not have a great deal of familiarity with CVI and its characteristics. We will skip over questions that do not contain any data for our data collection sheet unless they bring up interesting questions regarding visual behaviors. We recorded our remarks on the part of the data collection sheet marked "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 the questions are getting at.

Sara:
Question 1 asks what to do to get Brandon interested in something. His family says to put the item in his hand to hold, which places no demands on vision, but his classroom staff says that among other things, they shake it, or put it on a light box and move it. So on the interview data collection sheet, we made a note of that in the "need for movement" and in the "light" rows.

Question 2 asks about knowing how Brandon sees something. Answers include head orientation toward the object and a slow reach, usually with a light box or with art. Since we don't know the visual qualities of the art, we can only mark this one in the row for "light" in that he orients his head towards the light box.

Question 3 asks about Brandon having a favorite side or head position. His family said his right side is his favorite side. We observed that too, in that he uses the right side of his body and his right hand more frequently. We may suspect that Brandon would prefer his right eye as well, but we know that he has retinal detachment in the right eye. His classroom staff were more tuned-in to vision-related behaviors, and they noticed that he uses his left side for viewing, and they also said his head was "slumped". This might mean that he has an upper field preference. At any rate, he definitely has a left field preference, which we marked in the row labeled "Field preferences".

Question 4 asked about searching for objects visually vs. tactually, and it was noted that he prefers finding things by touching and does not "usually" find them by looking alone. That would lead us to wonder what the environment is like on those rare occasions when he is able to find things visually.

Sara:
Question 6 asks about fields: where do you hold things when presenting visually. The answer also alludes to distance viewing. School staff reported "center, to left side within 1 foot range" which we recorded in the row called "Field Preferences" as "center left" and in the row called "Distance Viewing" as "within 1 foot".

Question 8 asks about what doctors have said about Brandon's vision. The family's answer is telling: totally blind, "but I don't think so." That means that they do see visual behaviors at home.

Lynne:
Question 9 asks about when Brandon likes to look at things. School staff said he will look at things that are on the light board and will look when he hears sounds, which seems to mean he alerts to sounds by turning his head. We recorded this response in the row called "Light".

Question 10 asks about what colors Brandon prefers to look at. Instructional staff said "maybe red". We recorded the response in the row called "Color."

Sara:
Question 12 asks about Brandon's response to ceiling fans and lights. His family noticed that he looks up towards these things. We recorded this information in the row called "Need for Movement" and in the row called "Light".

Question 13 asks about what Brandon does when he's looking at something, or how he positions his head. The school staff answered that he puts his face on things, which we recorded in the row called "Distance."

Lynne:
Question 14 asks whether Brandon notices things that move faster than he notices things that don't move. His family said he notices things that move. We recorded that answer in the row called "Need for Movement".

Question 16 asks again about color preference. School staff again tentatively said "red" which we recorded in the row called "Color".

Sara:
Question 18 asks about Brandon's head position while reaching. His family said "straight". We recorded this information in "Field Preferences" and in "Visually Guided Reach."

Question 19 asks about what Brandon does in response to new things. School staff said he reaches out to touch them. We recorded that response in the row called "Visual Novelty" and in the row called "Visually Guided Reach."

Question 20 asks about positioning Brandon (or items) so that he can see them best. School staff said left side positioning and light as helpers, so we recorded their response in the row called "Field Preferences" and in the row called "Light."

Sara:
Our phase I case study is a young man named Brandon. Brandon was born prematurely and developed retinopathy of prematurity, or ROP. Sometime between the most recent functional vision evaluation and the last eye doctor visit, the retina in his right eye became completely detached. A recent low vision evaluation reported Brandon had no light perception in his right eye, and he had form perception in the left and that his field was restricted to 40 degrees. Brandon's eye report also identified right esotropia and optic atrophy. These ocular conditions may have a large impact on Brandon's ability to take in visual information and get the experience needed to resolve some CVI characteristics.

Lynne:
Along with the ocular visual impairment caused by damage to his retina, Brandon also has a history of having a closed head injury, which is one of those red flags when thinking about visual behaviors a person might have due to neurological differences or changes.

Lynne:
Some other information about Brandon you might want to know is that he uses an object calendar to communicate receptively, has cerebral palsy which affects all of his limbs, uses a wheelchair to move from one place to another, and he has a seizure disorder which is well controlled.

Sara:
Socially, Brandon is super active. He really enjoys verbal and sound related interactions with other people, especially when they make funny noises or talk in silly voices. He engages others in this sort of interaction regularly, and initiates it by greeting them or by laughing and turning his head toward them. He makes specific requests by verbalizing stuff like "Hug," or "Eat."

Lynne:
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.

Sara:
The plus statements in Rating I of the CVI Range can be used to determine present levels of visual functioning: we also used the more specific description provided in the CVI Range Scoring Guide under the plus column. For Ian, these are the plus statements:

"Latency (is) present only when (Ian) is tired, stressed, or overstimulated."

Ian has a "delay in directing (his) visual attention toward a target only when experiencing fatigue or inappropriate levels of multisensory input."

Ian is able to participate visually in routine events, though in non-routine events or when presented with many novel items, Ian may have a more and more difficult time looking, particularly at additional novel items.

Lynne:
Ian regards familiar faces when voices do not compete: Ian is able to glance at or look "directly into faces of familiar people, but only when the familiar person is not speaking."

"Simple books, picture cards, or symbols [are] regarded" by Ian: he "visually attends to two-dimensional materials that have little complexity and that include one- to two-color images."

"Selection of toys or objects [is] not restricted."-Ian "is able to visually examine and/or interact with objects of any color and of any surface pattern, even if they are novel."

Sara:
Ian has "no color or pattern preferences"

"Color highlighting or pattern adjustment or highlight is not required for visual attention." It's not required, but it does make things easier.

Ian's "visual attention extends beyond 20 feet."

Ian "is able to visually locate and/or fixate on certain targets at distances up to and possibly beyond 20 feet away."

Ian "uses vision to imitate actions."

He is able to repeat "actions in response to a direct model."

Lynne:
Ian "demonstrates memory of visual events"

He "demonstrates recognition of a person, place, or event that has occurred in the past." "Look and reach [are] completed as [a] single action" for Ian. Ian uses visually guided reach most of the time, even with complex backgrounds, but occasionally looks away just as he is reaching. This may happen more when he is tired or stressed.

Sara:
The numbers on Rating II, or the highlighted areas of the CVI Resolution Chart, can be used as a helpful guide to appropriate modifications for your student. Here is what that might look like for Ian:

Christine Roman states that instruction for a student, such as Ian, with a high resolution of CVI characteristics, has two main themes: teaching sorting skills with reference to the concepts of alike and different, and disembedding salient features from a background. Learning how to compare and contrast the visual properties of objects supports the ability to analyze novel information and complex situations. Learning to differentiate a feature or object from a background supports the development of the ability to differentiate details and make fine visual discriminations.

Lynne:
Ian does not require a certain color to be able to visually attend to items, but having a primary color does seem to help focus his visual attention. Use labeled color photographs of items, places, etc., that contain color as symbolic representations in Ian's daily schedule and activities. Drawn pictures may also be useful as an organizational tool within lessons, especially if Ian is involved in the drawing and labeling process. These labeled pictures may take the place of written notes. Perhaps experiment with bold print on a red or yellow background to see if this aids in his sight word recognition. The goal is to allow Ian access to a learning media that does not depend on another person to deliver it. Ian may not be able to recognize either the picture or the word at first, but through consistent exposure he may be able to more easily process the information to the point of the picture no longer being necessary. Use bright primary colors to create templates to help Ian's organizational skills so that he does not visually lose items he uses often, the way he would when items are in baskets or are in a pile. For example, on his dresser, create an outline, with adequate free space around it, in the shape of things like hygiene supplies, cd player, ipod, etc, so that he can put items back in their location and easily find them again.

Ian does not require movement for visual attention. In fact, when he is upright and walking he is also concentrating very hard on those motor skills, and his ability to see becomes more difficult. It will be easier for Ian to perform complex visual tasks when his body is stable and seated.

Sara:
Latency and novelty are not separate areas in Ian's case, so they will be addressed at the same time. Ian is able to look at and especially identify familiar items much more readily than those that are unfamiliar. When he is asked to look at many new items he may tire out easily. Periods of sustained viewing of novel items should be limited to ten minutes max. Reduce visual demands when Ian is participating in a novel setting or routine. Give him extra time to process and respond to visual targets. When setting up a visit to a novel setting, or participating in a new routine, it may be helpful to consider the reduction of background noise by selecting a time when the area is less busy, or by turning down distracting sounds like the radio. It might be helpful to take pictures of the visual targets in the novel setting, and then preview them with Ian, adapting them to help point out the visual target in the setting by occluding some of the background, such as with a black frame. He then may compare the picture to the setting when he arrives, with assistance. Allow Ian time to study a novel object or word before requiring a response. Perhaps he could be given the opportunity to examine materials for an upcoming lesson without adult intervention so that he has some degree of visual recognition of the task.

Ian is able to use all visual fields, though with items that are complex, particularly small items and two dimensional items, he may need to move closer to examine them. It may reduce fatigue to place items on a black slant board so that he does not have to lean over.

Lynne:
When Ian is looking at you, lengthen the amount of time he can look at you by waiting to talk for a little bit. Ask Ian to keep looking at you while you say one particular thing in social contexts, such as, "Thank you," so that he can practice maintaining his gaze upon a person's face with familiar auditory input. Encourage Ian to look at new people in social contexts, even if just briefly. Use photographs of familiar items, settings and people to represent the activities in Ian's day. To help Ian practice sorting by looking at salient features of photographs, use activities such as grouping photographs of people by different attributes (eye color, hair color, etc.). Use strategies to isolate salient features, such as one brightly colored item that is always present in that setting.

Start with a close up view and when those are easily understood, take photographs from different perspectives and continue to identify those salient features. Introduce Ian to line drawings, if they are frequently encountered in everyday life, so that he can become familiar with them. Use some sort of occluder to block out excess detail on a page of images or symbols. For example, block out all but the individual word that is being read.

Experiment with spaces between letters in words to see if it is easier for Ian to recognize the interior letters when they are farther apart. Also experiment with outlining high frequency sight words in red to assist Ian in recognizing the shape of the word. As he is able to identify words with increasing accuracy, those shapes can be faded, first with a black line, then with a dotted black line, then with no line. Make sure the line hugs the shape of the word very closely. For most people with typical vision, sight word reading is done by recognition of the shape of the word, not the individual letters.

Ian has typical responses to light. He may like to wear sunglasses outside when it's sunny, but don't we all?

Sara:
Ian is able to attend to familiar items and locations beyond 20 feet away. To reinforce this, during travel, it may be helpful to have photographs that can help Ian identify landmarks. Photographs may be taken from closer distances and then compared at that distance, and then from increasing distances can be compared at those distances. This can also help Ian with complexity issues.

Allow Ian tactual access to objects to assist in recognition. Also, encourage exploration of objects to increase Ian's knowledge of the tactual properties of objects as they relate to the visual aspects. Encourage Ian to look at and manipulate objects at the same time.

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 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 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.

Lynne:
For Ian's CVI Resolution Chart, in the first row, color, we put an X in the first four boxes. Ian did not seem to be restricted to looking at specific colors, though we noted that he continues to be more drawn to red and yellow items. He can look at about anything. We highlighted the last column in that row, Range 9 to 10, because we did not see Ian needing specific colors or patterns in order to look.

In the second row, need for movement, we also put an X in the first four boxes. The last column in Range 9 to 10 was the one we highlighted, "Typical responses to moving targets."

Sara:
In the third row, visual latency, we put Xs in the first two boxes because we did not see latency very much, except when Ian was "tired, stressed or overstimulated," which was what we highlighted in the third column, Range 5 to 6.

In the fourth row, visual field preferences, we marked the first four columns with Xs and highlighted the last column, "visual fields unrestricted," in range 9 to 10.

Lynne:
In the fifth row, difficulties with visual complexity, things were not so clear cut. We marked the first two columns with Xs, since Ian was able to look when the environment wasn't all that controlled. We highlighted "Regards familiar faces when voice does not compete" in range 5 to 6. The other statement in range 5 to 6, "Student tolerates low levels of familiar background noise," seems to be resolved. In Range 7 to 8, we highlighted all of the statements.

Sara:
In the sixth row, light-gazing and nonpurposeful gaze, we put X's in all of the boxes. If there was a statement in range 9 to10, we would have highlighted that, in that Ian behaves typically around light sources.

In the seventh row, difficulty with distance viewing, we saw this characteristic resolved at all levels up to range 7 to 8 and marked those with Xs. We highlighted the statements in range 9 to 10, the last column.

Lynne:
In the eighth row, atypical visual reflexes, we found Ian to be resolved through the first four columns, and highlighted the last column, "Visual reflexes always present; resolved." which was in Range 9 to10.

In the ninth row, difficulty with visual novelty, we found that Ian was able to look at most new items, but not all. We could not highlight the last column, "selection of objects not restricted," and even though we weren't sure he exactly needed warm up time, we highlighted that box, since he definitely did not require "known objects to initiate a looking sequence". This was highlighted more as a process of elimination.

Sara:
In the tenth row, absence of visually guided reach, we found the statement, "Look and touch occur together consistently," to be the best description of Ian, and that the descriptions in the first four columns were resolved. We highlighted the last column in range 9 to 10.

Ian did not have any items that were circled because he has no identified ocular condition.