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Lynne:
Now we'll look at the forms in the back of Christine Roman's book, 2 pages after 185, 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 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:
We found all of the characteristics in CVI Range 1 to 2, Student functions with minimal visual response and Range 3 to 4, Student functions with more consistent visual response, to be resolved, or marked in the "R" column, from notes on all three of our data sheets. In CVI Range 5 to 6, Student uses vision for functional tasks, we found all to be in the "R" column except two items. For the third statement in that section, "Latency present only when the student is tired, stressed, or overstimulated," we found the plus statement on the CVI Range Scoring Guide to be the most true for Ian, "Delay in directing visual attention toward a target only when experiencing fatigue or inappropriate levels of multisensory input." For the ninth statement, "May regard familiar faces when voice does not compete," we found the plus statement, "Glances at or looks directly into faces of familiar people, but only when the familiar person is not speaking," to be the most true for Ian.

Lynne:
In CVI Range 7 to 8, Student demonstrates visual curiosity, we found all statements to be resolved again except two. For the fourth statement, "Latency rarely present," we found the plus-minus statement to be the best description of Ian's visual behaviors, "Novel objects, complex environments, or fatigue may increase degree of delayed response," and so we marked that one on the assessment form. For the tenth statement, "Simple books, picture cards, or symbols regarded," we found more support for the plus statement in our data, "Visually attends to two-dimensional materials that have little complexity and that include one- to two-color images."

We marked the eighth statement as resolved, but you may not find this information in our data sheet: we realized this and went back and asked people who know Ian well about more specific behavior around mirrors. They remarked that Ian wasn't all that into looking at himself in the mirror, but would show interest in looking at himself when he was dressed up strangely, like for Halloween. So he doesn't get points for vanity, but we still believe this particular statement to be resolved, given his ability to look at other people's faces in fairly complex environments.

Sara:
In CVI Range 9 to10, Student spontaneously uses vision for most functional activities, we found a sharp shift to plusses, plus/minus, and even one minus, and none that were resolved. The first item, "Selection of toys or objects not restricted," we found the permutation under the plus column best described Ian, "Is able to visually examine and/or interact with objects of any color and of any surface pattern, even if they are novel." The second item, "Only the most complex environments affect visual response," we found to be most correct in the version described by the plus/minus statement, "Demonstrates visual curiosity in familiar environments that have low degrees of sensory complexity." The third item, "Latency resolved," we found to be a minus for Ian, "Demonstrates a delayed visual response to targets when tired or overstimulated."

Lynne:
The fourth item in this section, "No color or pattern preferences," we found to be the best fit for Ian in the plus column, "Color highlighting or pattern adjustment or highlight is not required for visual attention." It's not required, but it does make things easier. The fifth item, "Visual attention extends beyond 20 feet," we found the best fit for Ian in the plus statement as well, "Is able to visually locate and/or fixate on certain targets at distances up to and possibly beyond 20 feet away."

For the sixth item, "Views books or other two-dimensional materials, simple images," we found the plus/minus statement to best align with the data we gathered from Ian's visual behaviors, "Detects or identifies familiar elements in familiar two-dimensional, simple materials."

Sara:
For the seventh item, "Uses vision to imitate actions," we found the plus statement to be the most accurate for Ian, "Repeats actions in response to a direct model." We did not have this information on our data sheets but rather gathered it from a more general knowledge of Ian's social behaviors. We found this same knowledge also applied when examining the seventh statement, "Demonstrates memory of visual events," and decided that the plus statement was also appropriate here, "Demonstrates recognition of a person, place, or event that has occurred in the past."

The eighth statement, "Displays typical visual-social responses," we found to be best described for Ian in the plus-minus column, "Demonstrates appropriate affective social responses with familiar people."

Lynne:
The ninth statement, "Visual fields unrestricted," we found the plus/minus statement to be a great description, "Demonstrates greater reliance on peripheral fields; may continue to use near viewing for two-dimensional materials."

For the tenth item in this last section, "Look and reach completed as a single action," we found Ian was best described by the plus statement, "Uses visually guided reach, but may be affected by size of target or complexity of background." The last item, "Attends to two-dimensional images against complex backgrounds," was more challenging for Ian, and we found him to function more like the plus/minus definition, "Is able to identify salient features in adapted two-dimensional materials with backgrounds of low complexity."

Sara:
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 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."

That would put Ian in the last section, CVI Range 9 to10, and since he has three plusses in the first half and three plusses in the second half, we would give him the higher of the two numbers. Rating I for Ian would be a 10.

Lynne:
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 Ian was able to visually attend to many different colors and patterns, and though red and yellow seemed to draw his attention more, they were not necessary for him to look. We scored this characteristic as 1 (Range 9 to 10).

Sara:
For number 2, need for movement, we found Ian responded just a bit more quickly to movement, but that it seemed to be a fairly normal response. We also scored this characteristic as 1 (Range 9 to10).

For number 3, visual latency, we found that Ian consistently took longer to look when he was tired, so we scored that as .5 (Range 5 to 6).

For number 4, visual field preferences, we found Ian didn't have any field restrictions, and scored him in Range 9 to 10 with a 1.

Lynne:
Number 5, difficulties with visual complexity, seemed to be a specifically interfering characteristic for Ian, and we scored him in Range 5 to 6 with a .5, since he still had some trouble at this level with faces.

For number 6, light gazing and non-purposeful gaze, we found no difficulty or irregular behaviors in relation to light, so we scored that characteristic as resolved with a 1.

For number 7, difficulty with distance viewing, we found Ian to be in the 9 to10 range, in that his vision extends beyond 20 feet, especially with familiar items. We scored that as a 1.

Sara:
For number 8, atypical visual reflexes, we found this characteristic to be resolved for Ian, and scored this with a 1.

For number 9, difficulty with visual novelty, we found that the most resolved statement wasn't always true, and that selection of objects might not be completely unrestricted, so scored that characteristic at Range 7 to 8 instead, or .75.

Lynne:
The last characteristic, absence of visually guided reach, we found also to be resolved, so number 10 was marked as 1, (Range 9 to10).

So adding all ten numbers up, for Rating II we got a total of 8.75. So Ian's score for Rating II was recorded on the first page as an 8.75, making his CVI Range from 8.75 to 10, with a difference of 1.25.

Sara:
Sara: Ian was assessed in several different environments over the course of two testing sessions. The first and last are familiar classroom environments, the middle is the cafeteria. Due to his visual fatigue, Ian could not be assessed for longer periods. We made our notes on the data sheet called "Direct Assessment Information."

In the first clip, skittles are laid out on the table for Ian to find (and eat). He is able to find all the skittles in his lower field. Let's watch clip 1.

[video clip 1]

>>Teacher: They're skittles, you can eat 'em. You can eat 'em. They're for you for helping me with my homework. Ok. [Background voices] Awesome.

Sara: The very beginning of the clip got cut off, but the first skittle that Ian reached for was the red one. The second one was the yellow one. Those colors still seemed to draw his attention first, so we marked that information in "Color." Also, since Ian was able to find all items in his lower visual field, we marked that in "Field Preferences."

Lynne:
In the second clip, I bring an item into Ian's peripheral fields, first just holding it fairly still and then wiggling it.

[video clip 2]

>>Teacher: Now I'm going to be putting some stuff around you, but can you stare straight at Linda and just tell me when you can see what I have in my hand.

>>Ian: Alright.

>>Teacher: Try not to turn your head.

>>Ian: Yep.

>>Teacher: You can see it now? Ok. Can you look at Miss Linda again?

>>Ian: Yep.

>>Teacher: Ok, Ok, look at Miss Linda.

>>Ian: Yep.

>>Teacher: OK.

>>Ian: Yep. Yep.

>>Teacher: Alright! [Bell rings.]

>>Ian: Yep.

>>Teacher: Cool. And you'll see it coming around. Oh, what is that? I have no idea! It's a decoration.

>>Ian: It's a, it's a, yeah.

>>Teacher: Ok, thank you.

Lynne:
Ian responded to the item in his peripheral fields. He might have responded a little more quickly when the item was wiggled, but it's hard to tell. We wrote a note about that in the row called "Field Preferences."

In the third clip, I present Ian with a variety of pictures and invite him to say what he thinks they are. I begin with photos and end with some boardmaker line drawings. This is a long clip with a lot of information for our assessment data sheet. Let's watch.

[video clip 3]

>>Teacher: Can you tell me what that is?

>>Ian: Um-hum.

>>Teacher: You can pick it up if you want.

>>Ian: Ok. A picture.

>>Teacher: A picture? Can you tell what it is?

>>Ian: Um-hum. A car.

>>Teacher: A car.

>>Ian: Um-hum. It's a guy.

>>Teacher: Can you tell who that is? No? Ok. But it's a person?

>>Ian: Um-hum.

>>Teacher: Ok. Thank you. How about this?

>>Ian: There's people.

>>Teacher: There's a lot of people, yeah. They're in a place on campus. Can you, do you know, can you tell where they are?

>>Ian: What's it called..um-hum. Cafeteria?

>>Teacher: Cafeteria! You got it. What about this place?

>>Ian: Um. Music room?

>>Teacher: Music room?

>>Ian: Or the auditorium.

>>Teacher: Or the auditorium, yeah, it's a big room, isn't it. How about this picture?

>>Ian: A girl, a lady.

>>Teacher: It's a girl.

>>Ian: Um-hum.

>>Teacher: You know who she is?

>>Ian: Uh-uh.

>>Teacher: No? Ok.

>>Ian: Building?

>>Teacher: It's a building. Can you tell where it is? It's a building on campus.

>>Ian: I have two things I think it is.

>>Teacher: Ok.

>>Ian: Is it um, the rec center?

>>Teacher: No, but that's a good guess though.

>>Ian: Health center?

>>Teacher: Nope, but that's a good guess too!

>>Ian: The gym?

>>Teacher: Ha ha ha, look let me show you this one. Does that help you figure out where it is?

>>Ian: Pool?

>>Teacher: It's the pool! When you look at a picture, Ian, does it make it easier for you to see it if it has this yellow around it?

>>Ian: See, this is kinda harder, can't see it. This one is easier to see coz of the blue.

>>Teacher: Because of the blue color?

>>Ian: Of the water.

>>Teacher: So you could tell easier from this picture?

>>Ian: Yeah.

>>Teacher: Ok. Thank you. Look at this picture.

>>Ian: It's outside?

>>Teacher: It is outside.

>>Ian: Um...

>>Teacher: You're not sure? It's ok. I'm just trying to figure out if we have pictures for you to put on your calendar, what they should look like. So I know you like colors in your pictures. Is this picture too black and white with a lot of shadows?

>>Ian: Yeah.

>>Teacher: So you can't really figure out where it is? It's the pavilion.

>>Ian: Yeah. I know that place.

>>Teacher: You knew that was your next guess? Ha ha ha. Ok, can you tell me what that is?

>>Ian: Red thing? I know what it is. It's a stop sign.

>>Teacher: It's a stop sign. It's a red thing. Ok. Awesome. Ok. Now these aren't photographs, but they're pictures. Can you tell me what that's a picture of?

>>Ian: Is it at the high school?

>>Teacher: No, it's nothing at school. Can you tell what it is? Somebody drew it to mean something. Can you tell what it means? Or not. It's ok if you can't.

>>Ian: Does it tell time?

>>Teacher: Does it tell time? No, that's a good guess, though, because it's kind of round isn't it, like a clock. It's supposed to be a picture of a smiley face. And this word is "happy." It's a picture that means somebody's happy. Ok, how about this?

>>Ian: Um, yellow sign.

>>Teacher: A yellow sign?

>>Ian: Um-hum.

>>Teacher: It is yellow.

>>Ian: Uh-huh.

>>Teacher: Uh-huh, thank you!

>>Ian: Outside, black flower.

>>Teacher: A black flower? It's supposed to be a black spider. A big spider. Ah!

Lynne:
We marked information from that clip in "Color" and noted that the yellow outline of the picture didn't help, but the salient features that were accented with color helped him identify what the picture was, like in the case of the blue water for the pool photograph. In the boardmaker pictures, he noticed the red in the stop sign, and yellow on the line drawing of the bus, which he identified as a yellow sign. We wrote notes in "Need for Movement" because he moved one picture that he was having difficulty seeing.

Sara:
We put a great deal of information from that clip in the fifth row, "Complexity." He identified correctly the non-complex photo of a white van (as a car), the complex photo of the cafeteria, and the gender of people in photographs. He couldn't tell who any of the people were, though they were people he recognized in person. Photos with bad lighting or low contrast were difficult for him to even guess at. He could pick out some salient features in the boardmaker symbols though he couldn't correctly identify any of them. This would be a complexity issue in designing a calendar system that is the easiest to see: he seems to respond best to photographs.

We marked this one in "Distance Viewing" as well, because Ian moved closer to view these two-dimensional items, though it may really have been that he was trying to reduce complexity.

Lynne:
In clip 4, I take the pictures that Ian correctly identified when presented by themselves and place them on a cluttered background; a piece of cloth with a busy design. I ask him to find the pool, which was the one that he seemed to be able to most easily see presented singly.

[video clip 4]

>>Teacher: One more thing. I'm going to spread this out. And then I'm going to put these pictures on it that you recognized before. Can you show me the picture of the pool?

>>Ian: It's hard.

>>Teacher: It's hard on that background isn't it. Alright. Thank you!

>>Teacher: One more thing. I'm going to spread this out. And then I'm going to put these pictures on it that you recognized before. Can you show me the picture of the pool?

>>Ian: It's hard.

>>Teacher: It's hard on that background isn't it. Alright. Thank you!

Lynne:
We put notes about "Movement" on our data collection sheet from this clip. Ian moved his head a great deal when trying to locate the picture. He may have been trying to activate his visual system, which could be a strategy that helped in the past with objects or with less complex pictures. He also moved closer, and we made a note of this in the "Distance" row, though this may have also been a complexity reduction strategy.

Sara:
In the fifth row, we also recorded information about this clip: Ian was able to find the white van on the crazy background, which may have been the only picture that presented a large enough single color spot to see amidst all the clutter. The yellow outlined picture did not help him see it.

One interesting thing that happened was that on that crazy cluttered background, Ian looked at and reached for the picture he had picked. He did not look away. We marked that in the row for "Visually Guided Reach."

Clip 5 involves Lynne laying out a bunch of colored chips in a row and asking Ian to tell her what colors they are. Let's watch clip five.

[video clip 5]

>>Teacher: Almost done, Ian. Are you getting tired? Getting tired of looking? Ready to go to math? Ha ha. Ok, can you name these for me one by one in any order you want?

>>Ian: Um-hum. Yellow.

>>Teacher: Yellow?

>>Ian: You want the shape?

>>Teacher: Just tell me the color.

>>Ian: Color, not shape?

>>Teacher: Not the shape.

>>Ian: Alright. Yellow. Green.

>>Teacher: Thank you.

>>Ian: Blue.

>>Teacher: Blue.

>>Ian: Red.

>>Teacher: Thank you.

>>Ian: Orange.

>>Teacher: Orange. Lovely. Alright. Thank you!

Sara:
We marked this one in the first row, "Color," because Ian again had a difficult time telling the red and the orange apart, especially when they were right next to each other. He moved them apart and then was able to tell which was which. He also tended to pick the color on the end. We marked those two things in "Complexity," because having space around them really seemed to help him identify them, especially those red/oranges. We noticed that he moved closer to these small items, which we marked in "Distance."

Lynne:
Clip 6 shows Ian briefly in the cafeteria. We play a game called, "Who is it?" Ian is asked to identify familiar people before they talk to him. Let's watch.

[video clip 6]

>>Teacher 1: Got it, alright! Ok, next contestant on who is it?

>>Ian: Tara!

>>Teacher 2: Hi Ian! [Laughter]

Lynne:
Ian is able to visually identify two people who go to the cafeteria with him regularly. We recorded that in the row, "Complexity."

In clip 7, Ian is back in a familiar classroom setting, the computer lab. A familiar person comes into the room and Ian has trouble identifying him, perhaps because he is out of context. Let's watch.

[video clip 7]

>>Teacher 1: Hey Ian, who is that next to you on the other side of you? Who is that?

>>Ian: Yep.

>>Teacher 1: You know?

>>Ian? Um-hum.

>>Teacher 1: You know? Ok.

>>Ian: I know.

>>Teacher 1: You know. Can you think of the name?

>>Ian: Um-hum. Um-hum.

>>Teacher 1: Can you tell me? Girl or boy?

>>Ian: Guy.

>>Teacher 1: Hmm?

>>Ian: A guy.

>>Teacher 1: A guy?

>>Ian: Um-hum.

>>Teacher 1: You need more clues?

>>Ian: I got it.

>>Teacher 2: What about the ID?

>>Ian: I know who it is!

>>Teacher 1: Do you know who it is?

>>Ian: Um-hum. I know.

>>Teacher 2: What's his name?

>>Ian: His first name starts with a J.

>>Teacher 1: Um-hum.

>>Ian: And then an O.

>>Teacher 1: Um-hum.

>>Ian: And then an L.

>>Teacher 1: Um-hum.

>>Ian: And it's Joel!

>>Teacher 2: No....

>>Ian: Not Joel? Then it's, then it's.

>>Teacher 2: [quietly] John.

>>Ian: John!

>>Teacher 1: John, Ok. Perfect.

Lynne:
We recorded this information in "Complexity," though we wondered if it might have been a language retrieval problem, like what Ian's mom talked about. He identified the gender of the person correctly but thought it was a different guy.

Sara:
In clip 8, Ian is presented with novel items. Though he is able to detect all of these things, he sometimes has to use other senses to figure out just what they are.

[video clip 8]

>>Teacher: Try to see if you can tell what it is, ok, before you touch it.

>>Ian: Alright.

>>Teacher: Ok, thanks for being so patient.

>>Ian: A cup. A cup.

>>Teacher: Cool. Now tell me what you think this might be before you touch it. Ohhhhh...cheating, cheating!

Sara:
Ian used auditory clues to support visual information about the cup: the cup made a noise when it was placed on the table. He labeled it from visual and auditory information alone. He also leaned in to try to identify the "book," and relied on his tactile sense to figure out what it was. We marked this in "Complexity," because Ian employed other senses when vision didn't do it, and in "Novelty," since he detected these new things right away, and in "Distance" since he moved so close to the one he had trouble with. We also recorded these two responses in "Visually Guided Reach," since he reached directly toward these novel items and did not look away.

Lynne:
In clip 9, Ian is presented with a visually complex item, which he detects and picks up immediately, but then looks away while he is picking it up.

[video clip 9]

>>Teacher: What else have we got here in this bag of goodies? Wah-ha-ha ha. What's that?

>>Ian: A ball.

Lynne:
This is late in the testing session and Ian may be tired. We really didn't see him examine this object visually, only tactually, which we recorded in "Complexity." We marked it in "Visually Guided Reach," since he looked away right before picking up the item.

We'll go ahead and look at clip 10, though it is really hard to see Ian's response because it is subtle. Sara brings her hand toward Ian's face to see if he blinks to threat, which he does, but it is barely perceptible from the video. Same thing for the blink to touch.

[video clip 10]

>>Teacher: I'm gonna do this. Whoops! Ready? Yeah. You blinked. Thank you.

Lynne:
We were there, so we know he exhibited a blink reflex, but if you were going from video alone, you might think he didn't. There are ups and downs to using video to assess CVI characteristics! We recorded that information in "Atypical Visual Reflexes."

Sara:
A couple additional notes we made when looking at all these clips is that Ian detected all novel items and looked at most of them, though he couldn't always tell what they were. We also noticed that while Lynne was working with Ian, he looked at her, but looked away immediately nearly every time she began to talk. We made notes of these overall observations in the rows "Complexity" and "Novelty."

Sara:
Sara: During this observation, Ian goes with his Orientation and Mobility instructor to a grocery store that he has not previously been to. Competing stimuli include the music piped into the store, the person videoing him -there's a little red light on the camera- and the general novelty of the environment. It is a motivating trip because Ian will get to buy his favorite gum. We will mark our results for this in the section of the data sheet called "Observation Information."

During clip one, Ian maneuvers himself into the van. He reaches for the door handle twice. The first time, it's not clear exactly where his gaze falls while reaching, but the second time, it is quite clear. Let's watch.

[video clip 1]

>>Teacher: Now you see that curb down there, right?

>>Ian: Yeah.

>>Teacher. Ok. Thank you. Oh, alright! First time going off campus for O&M! Yeehaw!

Sara:
So we made a note of that second reach in the tenth row, "Visually guided Reach," since Ian looked and reached simultaneously.

Lynne:
In clip 2, we see Ian and his O&M instructor enter the store. She asks him to identify some things on the shelf from about eight feet. He identifies the cooler, saying, "Drinks" and the items on the shelf, saying, "Fruit." Let's watch.

[video clip 2]

>>Teacher: Go all the way to the far wall. What do you see there without touching anything.

>>Ian: Drinks.

>>Teacher: Drinks and...

>>Ian: Fruit.

>>Teacher: Fruit? Cool! What kind of fruit?

>>Ian: Oranges...

Lynne:
We marked that observation down on the data sheet on the fifth row, "Complexity," since the environment was so complex, and in the seventh row, "Distance," since he identified items from a little ways away.

In the third clip, his instructor has asked him if he wants to feel some of the items on the shelf. He moves toward the red peppers and she asks him if he can pick it up and identify it. She then shows him an apple, which is not as deep a red as the pepper, and he identifies it as an orange visually, then after he touches it, he identifies it as an apple. Let's watch clip 3.

[video clip 3]

>>Teacher: You want to feel one? See what that red thing is: what's that? Ok you can pick that up. What is that? Is it a fruit or a vegetable?

>>Ian: Vegetable.

>>Teacher: It's a vegetable. Here, let's compare. So from a distance that might have looked like that. What's that?

>>Ian: An orange.

>>Teacher: It's an orange? Here, feel.

>>Ian: Apple.

>>Teacher: Apple, sure enough.

Lynne:
We marked the information from this clip in the first row, "Color," because he was drawn to the red peppers and in "Complexity," because of Ian's misidentifying the apple in a visually complex situation.

Sara:
The fourth clip involves his instructor asking him about the number of shelves, then whether the fruit is a lemon or lime. Ian leans in very close to try to take in the specific visual information.

[video clip 4]

>>Teacher: How many shelves do you see? Yeah? Yeah. Wanna count? What are those?

>>Ian: Um...I don't know.

>>Teacher: Is it a lemon or a lime?

>>Ian: Lemon.

>>Teacher: Lemon? Which one's a lemon?

Sara:
We marked the information from that clip in "Complexity," since Ian moved so close, perhaps to reduce the visual complexity, since moving close allows one to see fewer items.

The fifth clip is one of those that is very telling. Ian is asked to identify a fruit he is holding against a complex background and has a hard time telling what color it really is. It is suggested to him to move it so that the background is the plain, tile floor. After that, Ian readily identifies that the fruit is "kinda greenish." Let's watch clip five.

[video clip 5]

>>Teacher 1: What color do you see there?

>>Ian: It's hard to tell the color.

>>Teacher 2: Maybe where you're holding it.

>>Ian: It's kind of a, I guess a [inaudible].

>>Teacher 2: Hmm? Why don't you turn and not hold it over everything else?

>>Teacher 1: Here, come bring it over here so you have just like the floor underneath it, so not all that clutter. There you go. Can you stand over by me? Can you see what color it is there?

>>Ian: Kinda greenish.

>>Teacher 1: Kinda greenish! Cool! There you go.

Sara:
We marked that information in "Complexity."

Lynne:
Clip six is a repeat of the same kind of example. Ian is asked to identify an orange over the non-complex tile of the floor, and is able to immediately identify it.

[video clip 6]

>>Ian: Orange.

>>Teacher: That's an orange. Cool.

Lynne:
We marked that in "Color," because he seemed to have trouble before with the red/orange spectrum in not knowing which was which, and "Complexity," because of how well the strategy worked.

In clip seven, Ian is asked to go find a vegetable from a different part of the shelf. Out of the green, orange, purple, and yellow array, Ian goes immediately for the yellow squash. Let's watch.

[video clip 7]

>>Teacher 1: Alright. Alright. Thank you!

>>Teacher 2: Cool. Alright.

We marked that one down in "Color" as yellow is a color that Ian is more drawn to.

Sara:
In clip 8, Ian is being asked to identify what is on the top shelf. The grocery store soundtrack seems to have gotten louder, the area is cold, the array is cluttered, and Ian is tired. Ian seems to need extra time to identify the item that is there. Let's watch clip 8.

[video clip 8]

>>Teacher: Milk, uh huh. And how about the top shelf?

>>Ian: Fruit juice?

>>Teacher: Ok. Where's the top shelf?

>>Ian: Over here? Top shelf?

>>Teacher: Yeah, what's on the top shelf?

>>Ian: Here?

>>Teacher: No, right here. What's that? Yeah.

>>Ian: Eggs.

>>Teacher: Eggs, sure enough. So what department would these be?

Sara:
We marked that one in the third row, "Visual Latency," because of Ian's fatigue and him taking longer to look, and in "Complexity" because all the competing sensory information made this a more difficult task.

Clip 9 is similar to clip 8, but Ian is less successful. He is even more fatigued, the item being searched for is small and probably more complex. Ian tries to look at the shelf with the candy and gum and he can barely do it.

[video clip 9]

>>Teacher: How many shelves do they have with gum on it?

>>Ian: Right there.

>>Teacher: And where else? Ok, yeah. Any other shelves with gum on it right here in front of us here?

>>Ian: There?

>>Teacher: Uh-huh, there you go. Now you were telling me what gum you liked. You said Trident. Do you see Trident on there?

Sara:
We marked that one in "Visual Latency," because of the fatigue noticeably decreasing looking behaviors, as well as in "Complexity," because the visual target is extremely complex and Ian tries and tries to make sense of it, but doesn't seem to be able to.

Lynne:
In clip 10, we see Ian paying for his purchase. He does not look at the cashier at all.

[video clip 10]

>>Cashier: 2.15.

>>Ian: Is this good?

>>Cashier: Can I get 15 more cents?

Lynne:
We marked that information in "Visual Latency" as well as "Complexity." Ian does not look at the unfamiliar face of the cashier. It should be noted that during this observation, Ian glanced toward his instructor's familiar face infrequently. We see him do that briefly during this clip. It might also be noted that she was talking to him a great deal of the time during this observation.

In clip 11, Ian seems happy to be leaving that store, and begins heading toward the van as soon as they round the corner. He wants to go straight for it, but his instructor cautions him to stay near the wall.

[video clip 11]

Teacher: You're coming out the door on the left. Man! Hey Ian, you want to stay on the sidewalk until you get in front of the van, because you don't want to just cruise through the parking lot, ok? There you go. Staying close to the van. I don't think I locked it. There you go.

Lynne:
We marked that one in the seventh row, "Distance Viewing," since Ian is able to identify the van from 20 feet away, possibly a stingy estimate: It may be further than that.

Lynne:
We asked Ian's family and educators to answer questions about Ian's visual behaviors. Ian's classroom teacher, who is a teacher of the visually impaired, interviewed Ian's mother by phone and wrote down her answers. Sometimes she also added her own input when she saw something different from what mom saw, though this was infrequent. We will consider input from both parent and teacher when recording our information. We'll skip over questions that don't contain any information for us to record on our data sheet, unless they seem to bring up something to take note of. 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 the questions are getting at.

Sara:
Question 1 asks what they do to get Ian interested in an object. The answer said that he used to require movement and the color red but "they are past that." We marked that in the first row, "Color" on our data sheet, and in the second row, "Need for Movement."

Question 2 asks about how they know that Ian sees something when it is shown to him. His mom said she asks him to describe it, especially with objects. She commented that with pictures they "wonder if he is guessing." We recorded that information in the fifth row, "Complexity."

Lynne:
Question 3 asks if Ian has a favorite side or head position. It's reported that he tilts his head to the right, and seems to see things better if they are up or at eye level, and that it seems like he may have a hard time with things that are down and in front of him. We marked that data in the fourth row, "Field Preferences."

Question 4 asks if Ian usually finds objects visually or tactually. His mother answered mostly by looking, except when things were on the table in that lower field; he may sometimes find those by feeling. We marked that part of the answer in "Field Preferences." The next statement, "They had a big keys keyboard and he could tell you all the letters that were yellow," we marked in the color and complexity rows.

The last statement, "Using his hands and using his eyes at the same time was difficult," we marked in complexity, because it could be a complexity of the sensory environment issue and we also marked this in visually guided reach, because it could be a visual motor issue.

Sara:
Question 5 asks if there are concerns about they way Ian sees. There was a note that vision didn't seem dependable. Also there were concerns about reading. We didn't mark this down on our data sheet, but this concern seems very related to possible CVI characteristics.

Question 6 asks where someone would hold something for Ian to look at. His mom said at eye-level but that Ian can see "on any plane. It is the 2D that is trickier." We marked "eye level" and "on any plane" in "Field preferences," and 2D is tricky in "Complexity."

Lynne:
Question 9 asks about when Ian likes to look at things. The answer identifies that he sees best when he is awake and alert, and doesn't see as well when he is tired. We marked this answer on the data sheet in the third row, "Visual Latency."

Question 10 asks about Ian's favorite color of things to look at. HIs mother said, "If we are on the highway, he always points out yellow cars. Also things that are red. Bright colors. He is not dependent on color to see like he used to be." We marked that data in the row for "Color." We also marked it in "Distance" since he identifies cars on the highway from a distance.

Sara:
Question 11 asks about what Ian does near shiny and mirrored objects. His mother said this is not applicable now but that they used to get his attention. We marked that data in the row "Need for Movement."

Question 12 asks about Ian's response to lights or ceiling fans. He behaves normally around them. We marked that one in the sixth row, "Light."

Number 13 asks if it is easy to identify what Ian is looking at, and mom answers that it's sometimes difficult. We marked that one in the sixth row, "Light" as well.

Lynne:
Question 14 asks about whether Ian notices things that move or things that don't move first. His mom said movement used to be needed to get him to look, and it continues to help in getting his visual attention, but it is no longer required. We marked that one in "Need for movement."

Number 15 asks about Ian's head positioning while he is looking at something. His teacher said he may hold his head down and toward the left. We marked that in the row called, "Field Preferences."

Sara:
Number 16 asks again about favorite colors. Mom said that yellow & red seem to be what he responds to the most, though his favorite colors are the Laker's colors, Purple & Gold. We marked that in the first row, "Color."

Question 17 asks about whether Ian notices things in new places more, or in familiar places. Mom said he could point out landmarks or items of interest while traveling familiar routes on the highway. She thought unfamiliar situations might cause difficulty. We marked this data in the rows called "Complexity" and "Novelty."

Lynne:
Question 18 asks about how Ian holds his head when reaching toward something. His mom said that he "reaches with his left hand and his head is cocked to the right." His teacher said she thought she saw his head cocked to the left while reaching with the same hand. We marked this one in the row called "Visually Guided Reach."

Question 19 asks how Ian responds when given unfamiliar items to look at. His mom said that she's not sure whether language retrieval or vision would be the reason for the difficulty Ian has with new things. We marked that one in the row for "Visual Novelty."

Sara:
Question 20 asks again about positioning of materials. The answer applies to fields, with "eye-level" being mentioned as more successful than "things on the table," as well as complexity, when she says, "there can not be a lot of stuff competing with what he is trying to do," and that "he can point to details on a picture card..." We marked that information in the corresponding rows.

Question 22 asks what Ian does when he has many items in front of him to look at. Mom said, "That is overload. He may try but then it is just too much." We recorded that response in "Complexity."

Lynne:
Question 23 asks about Ian looking at faces. His mom said that he likes to look at a calendar of pretty girls' faces. We marked that in "Complexity," and in "Novelty" since the calendar girls are not familiar people.

Question 25 asks about the visual characteristics of Ian's favorite objects. His mom said he'll look at anything that is three dimensional, but the two dimensional things seem to cause trouble in looking. We marked that in "Complexity."

Sara:
Our phase III case study is a young man named Ian.  Ian has a diagnosis of CVI due to traumatic brain injury that happened 8 years prior to this CVI assessment.  According to his eye report, he has no interfering ocular conditions. 

Lynne:
Ian has pretty typical social and language skills, though he does at times have difficulties with word recall.  He’s had a hard time with reading since his accident, and currently uses a calendar with pictures supported by verbal reinforcement.  He’s a pretty easy going guy for the most part.  He does not think of himself as visually impaired.

Sara:
Maneuvering through space is challenging for him due to motor impairment on one side.  Oral motor skills were also affected and this, paired with the fact that Ian is rather soft-spoken, can make understanding his speech challenging.

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

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

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

Broad overview:

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

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

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

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

Parent interview:  

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

Indirect and direct assessment:

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

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

Data Collection

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

Rating 1

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

Rating 2

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

PLVF/Accomodations

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

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

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

End (of beginning)

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

Brandon Introduction Transcript

Transcript

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.”

Brandon Introduction Transcript

  1. Definitely interested in any kind of basketball, balls of any size (size doesn’t matter).  Doesn’t take much to get him interested in something. Before it may have needed movement or be a red color but they are past that. 
  2. I ask him to tell me about it.  That is where we have gotten to pictures.  Describe it for me and he does.  Especially objects in space.  In pictures we question and wonder if he is guessing. 
  3. He tilts to the right.  When we have worked on visual things especially with picture cards/ etc.  We always do them up or eye level.  (Such as on a white erase board more on the right then on the left).   He has a harder time attending to things that are down in front of him. 
  4. Most of the time by looking.  Sometimes when things are on the table I catch him feeling for items.  They had a big keys keyboard and he could tell you all the letters that were yellow.  Using his hands and using his eyes at the same time was difficult.  
  5. Yes, it is not something that is constant and you can have days that are different.  We will start understanding what he is seeing more and more.  The other part is that I am concerned about his vision in the way of reading and him being completely independent.  Three or four years ago they worked on sensitivity in his fingers for Braille.
  6. At eye level (best).  Ian can see objects pretty much on any plane.  It is the 2D that is trickier.
  7. Basketball, mixer, monkey (named Dexter), anything with the Lakers, Air Hockey table and his Wii.  His CD’s- he learned through repetition. 
  8. That they are 20/20.  There is nothing wrong with his eyes- it is all in the brain. 
  9. When he is awake and alert.  When he gets really tired it is hard to see.  It takes a lot of conscious effort to see things- low contrast.
  10. If we are on the highway, he always points out yellow cars.  Also things that are red.  Bright colors.  He is not dependent on color to see like he used to be.  Contrast definitely helps him see better/ he misses a lot of detail.
  11. These is not as applicable now- but early on it would get his attention.
  12. Doesn’t stammer on them.  He is normal around them. 
  13. Sometimes it is difficult.  Mom has been told that his peripheral vision in his brain is strong than his straight on focus. 
  14. When he first started getting into objects it required movement.  He probably attends to things better if they move.  He does not require it anymore.
  15. I don’t know.  (Maybe down towards the left, teacher thinks.)
  16. Purple/Gold (Lakers).  As far as visually yellow or red.
  17. If it is objects or when driving to san Antonio he can point out where they are.  In some unfamiliar situations it may be harder. 
  18. He reaches with his left and guessing that his head is cocked to the right (guessing to the right/teacher sees to the Left).
  19. Both the language retrieval and vision are when he has a difficult time with new things.  He knows what they are.  If you give him multiple choice he can retrieve it. 
  20. When they would do cards they did it at eye level.  He was not as successful when things were on the table.  There cannot be a lot of stuff competing with what he is trying to see.  He can point to the details of an object on a picture card and then he would be able to put those cards together and label the object.
  21. No
  22. That is overload.  He may try but then it is just too much.
  23. Pretty girl faces.  Calendar of pretty girls he would rather look at that! That is one of the suggestions one center had made about retraining Ian’s brain that there should be pictures of pretty girls and have Ian describe what they are doing different in the pictures.
  24. Depends on what the other object is. 
  25. Pictures of girls, basketball, etc.  Can be anything and any size. Flat and does not have the dimension that is the problem- it is not going to help just making it bigger. 

 

Interview Information

Color

1.  May have needed movement or to be a red color but he is past that. 
4. Could name large keys that were yellow. 
10. Yellow cars on highway, also red.  He likes bright colors.  (Is not dependent on color to see like he used to be.)
16. As far as visually: yellow or red.

Need for Movement

1.  May have needed movement or to be a red color but he is past that.
11. Shiny or mirrored objects not as applicable now, but early on it would get his attention. 
14. He probably attends to things better if they move.  He does not require it any more. 

Visual Latency

9. When he gets really tired it's hard to see: it takes a lot of conscious effort to see things.

Field Preferences

3. Tilts to the right.  Up or eye level on slant board easier.  Has trouble attending to things "down or in front" (lower field). 
4. Finds things on table by feeling instead of by looking. 
|6. Hold things at eye level.  15. Maybe down toward the left teacher thinks. 
18. Reaches with his left hand and guessing that his head is cocked to the right, teacher sees to the left. 
20.  Not as successful when things are lying on the table.

Complexity

2. He can describe objects in space, in pictures we question and wonder if he is guessing. 
4. Big keys keyboard: he could tell you all the letters that were yellow.  Using hands and eyes together was difficult. 
6.  Ian can see objects pretty much on any plane, it's the 2-D that is tricky.
17. If it is objects or when driving a familiar route he can point out where they are.  In some unfamiliar situations it may be harder. 
20.  There cannot be a lot of stuff competing with what he is trying to see.  He can point to the details of an object on a picture card… 
22. Many objects to look at=overload.  He may try but then it is just too much. 
23. Likes looking at a calendar of pretty girl faces. 
25. Flat and does not have the dimension that is the problem--it is not going to help just making it bigger.

Light

12. Is normal around lamps or ceiling fans. 
13.  Sometimes it is difficult to identify what he is looking at.

Distance Viewing

10. Looks at cars on highway.

Atypical Visual Reflexes

 

Visual Novelty

17. If it is objects or when driving a familiar route he can point out where they are.  In some unfamiliar situations it may be harder. 
19. Both the language retrieval and vision are when he has a difficult time with new things.  He knows what they are if you give him multiple choice he can retrieve. 
23. Likes looking at a calendar of pretty girl faces.

Visually Guided Reach

4. Sometimes when things are on the table I catch him feeling for them.  Using his hands and eyes at the same time is difficult. 
18. Reaches with his left hand and guessing that his head is cocked to the right, teacher sees to the left.

 

Interview Information

Color

10. & 16. Maybe prefers red.

Need for Movement

1. Move object to gain interest. 
11. No response to shiny objects/mirrors. 
12. Looks at ceiling fans
14. Notices movement.

Visual Latency

 

Field Preferences

3. Uses peripheral fields (left).
6. center left. 
18. Positions head straight while reaching. 
20. Position items on left side.

Complexity

23. Does not look at faces.

Light

1. Put object on light board to gain interest. 
2. Orients head toward light box.
9 Likes to look at things in front of light board. 
12. Light gazes. 
20. Position items on light box to help him see it.

Distance Viewing

6. Within 1 foot.
13. Puts face ON object to see it.

Atypical Visual Reflexes

 

Visual Novelty

19 Reaches out and touches new things. 

Visually Guided Reach

4. Primarily finds objects tactually. 
19 Reaches out and touches new things. 
18. Positions head straight while reaching. 

 

Observation Information

Color

Clip 2: Yellow not "favored." 
Clip 4: Blue is "favored." 

Need for Movement

Clip 3. Attends to large moving object at 3 feet.

Visual Latency

Cllip 2: Needed more time to look before he could process whoopee cushion visually. 
Clip 4: Several short glances before he could act.

Field Preferences

Clip 4 & 5: Definite preference of left central field.

Complexity

Clip 1: Is unable to look and touch at the same time with light environmental noise. 
Clip 2: Tried to use vision with small amount of environmental noise, then completely stopped when became more noisy. 
Clip 3: Uses vision briefly when noise does not compete (physical factors are also competing here).
Clip 4 & 5: Fixated on blue button briefly with little competing visual/auditory information, and later when teacher is talking.

Light

Clip 1: Light gazing during activity

Distance Viewing

Clip 3: Visually attended to large moving object at 3 feet (teacher walking in front of him) and identified as a person by saying, "Hello."

Atypical Visual Reflexes

 

Visual Novelty

Clip 4 & 5: Favorite object (blue button) elicited visual attention.

Visually Guided Reach

Clip 5: Looks and touches at the same time with familiar, motivating object.