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  1. Parent: If it plays music or lights up I push the button to make it do it.  If it is a toy without music or lights I hold it in front of her face to get her interested in it.  School: Make noise with it.  Mostly she finds things on her own.  Put it in her field.
  2. Parent: Cassie will grab it or reach for it.  School: She brings it to her face or moves it.  Looks out window of van when moving for the whole trip.
  3. Parent: Haven’t really seen a true preference but sometimes she’ll tilt her head up.  School: Holds head back, like when looking at faces.  Forward gait-eyelids partially closed.  Blocking field?
  4. Parent:  ½ by look and ½ by feel.  School:  Looking then touching.
  5. Parent:  Worry about lack of depth perception causing falls.  School: Nope, only curious.
  6. Parent:  I hold it about a foot to a foot and a half away from face directly in front of her eyes.  Sometimes I wiggle it.  School:  Right in front-central.
  7. Parent:  Her guitar, vacuum cleaner, closets.  School:  Accordion, rolling chair, pots and pans, keyboard, toy car (for crashing), swing, trampoline, slide.
  8. Parent: physically they are fine except for a little astigmatism in one eye.  School: No problem.
  9. Parent:  When they light up or glow if they vibrate or wiggle.  School:  Varies.
  10. Parent:  Haven’t really seen a preference.  School:  No major color preference.
  11. Parent:  If it’s very shiny she will squint her eyes.  She will be curious about them.  School:  No large attraction to shiny stuff unless it’s reflecting a lot of light.
  12. Parent:  Likes to see them turned on and off.  School:  Lights, especially to turn off/on.
  13. Parent: Majority of the time.  School:  Yes, because she’ll reach for it.
  14. Parent:  Notices things that move first.  School:  Both-she moves.  Can label when swinging.
  15. Parent:  Might slightly raise her head up.  School:  Varies.
  16. Parent:  Have not seen her make a preference for a specific color.  School:  No.
  17. Parent:  I would say more in new places.  School:  Doesn’t search things out in new places.  Runs through.  Moves all the time in new environment with no attention to detail.
  18. Parent:  Holds her head straight towards it for the most part but sometimes will turn head away.  School: Varies.
  19. Parent:  She will shake it and turn it over and around in her hands and then will look at it.  School:  Varies.
  20. Parent:  No.  School:  NA
  21. Have you ever been concerned about the way your child’s eyes move?  Parent:  No.  School:  NA
  22. Parent:  She’ll just take each one at a time and check them out.  School:  Looks less.
  23. Parent:  Her Mom’s Dad’s, and babysitter’s because they are faces of the people she knows, trusts, and loves.  School:  All.  She likes faces but doesn’t seem to differentiate.
  24. Parent:  For the most part she’ll check out the new object but sometimes she’ll choose the familiar object.  School:  Depends.
  25. Parent:  Likes toys or objects that are musical or light up or have soft texture. School:  Varies.

 

Interview Information

Color

10. No color preference noted.
16. No color pref. 

Need for Movement

2. Moves items, looks out window of van for whole trip.
6. Wiggle objects for C. to look at.
9. Looks at items that wiggle. 
14. Notices things that move first. 
17. Moves all the time in new environments, maybe to get bearings?
19. Shakes & turns over/around new things.

Visual Latency

19. With unfamiliar items, shakes, turns around, then looks: takes a little while.

Field Preferences

1. Get interested in toy by putting it "in her field." 
3. Tilts head up/back, lowers lids while walking so not to trip indicates lower field preference.
6. Present object directly in front/central.
15. Might slightly raise head up indicating lower field pref.

Complexity

2. Brings things close to view. 
22. When presented with large array, takes one thing at a time to look at or looks less.
23. Looks at familiar faces/ doesn't differentiate faces.

Light

1. Interested in toys that light up.
9. Looks at object when they light up or glow.
11. Squint if things are very shiny, attracted to things that reflect a lot of light.
12. Likes to turn lights on and off.  25. Likes toys that light up.

Distance Viewing

6. Present objects 1-1 ½ feet from face. 
2. Brings things close to view.

Atypical Visual Reflexes

 

Visual Novelty

17. Moves all the time in new environments: maybe to get bearings? 
19. Shakes, turns around new things, then looks. 
23. Looks at familiar faces.

Visually Guided Reach

4. Looks then touches to find object.
18. Sometimes will turn head away when reaching. 
19. First acts on new object and then looks at it. 

 

Observation Information

Color

Clip 3: Toothpaste tube has a striped pattern on the tube.
Clip 4: Reaches for stripes on wall (shadow). 
Clip 5: Picked up a single color yellow item from a complex array.
Clip 6: Out of an array, picks up a single color white item that has stripes.  
Clip 7: Looks at single-color item with stripes (comb).
Clip 10: Looking at Lynne's arm, which might be making a big stripe. Also looked at accordion, which has a striped pattern.
Clip 12: Looks at striped pattern (black on white). 

Need for Movement

Clip 3: Moves toothpaste while looking.  
Clip 10: Looking at Lynne's arm, which is moving. 
Clip 11: Saw moving teacher's hand from 15 feet. 
Clip 14: Movement draws attention in complex setting.

Visual Latency

 

Field Preferences

Clip 2: Holds picture close & in lower/central field. 
Clip 12: Places striped pattern on nose with eyes turned up for lower/central field viewing.

Complexity

Clip 1: Listening to/touching keyboard and not looking.  
Clip 2: Picks up picture and holds it close, blocking background.  
Clip 5: Picked up a single color item from a complex array.  
Clip 6: Out of an array, picks up a single color item that has stripes.  
Clip 7: Examined comb (single color, striped) but when she began to tactually explore, stopped looking. 
Clip 8: With song playing loudly, looks to locate but then find object tactually and picks up.  
Clip 9: Once music is turned off, looks at teacher's face (for the first time during observation) but looks away as soon as teacher vocalizes.
Clip 12: Held picture up to her face, blocking out background, and when she begins counting, stops looking.  
Clip 13: Descends the stairs tactually: stairs are more visually complex and they change constantly when moving on them.  
Clip 14: Looks at favored visually complex item in visually and aurally complex environment. 
Clip 15: Looks at teacher's face in visually and aurally complex environment, but looks away as soon as extra sound is added. 

Light

Clip 3: Abnormal response to light (Drawn to + squint).  
Clip 4: Stares at light and squints.  
Clip 7: Stares at reflection from metal can.

Distance Viewing

Clip 11: Saw moving teacher's hand from 15 feet.

Atypical Visual Reflexes

 

Visual Novelty

Clip 12: Places unfamiliar striped pattern on nose with eyes turned up for lower/central field viewing.

Visually Guided Reach

Clip 8: With song playing loudly, looks to locate but then find object tactually and picks up. 
Clip 13: Descends stairs tactually: is unable to look while reaching with foot, especially at end of stairs. 
Clip 14: Looks at favored item and reaches for it, but looks away just before touching it.

  1. Parent: Put toy in hand to hold.  School: Shake it, tap it, make noise, introduce it on his lap, put it on light board and move
  2. Parent: Not! Brandon is blind.  School: Head orientation towards object, slow reach out towards it.  (usually with light board or art)
  3. Parent: Right side.  Also head position. School:Left side for viewing, right side for most activity, usually head slumped.
  4. Parent: He is blind. School: Not usually motivated to look for items, but primarily touch when he does.
  5. Parent: No, he is blind. School: No answer.
  6. Parent: Put in his hand to hold only he is blind.  School: Center, to left side within 1 foot range.
  7. Parent: Piano, radio.  School: Radio, shakers, rain sticks, drums, instruments, keyboards.
  8. Parent: Total blind, but I don't think so. School: No answer.
  9. Parent: Not! He is blind.  School: In front of light board, he will look at sounds.
  10. Parent: None he is blind.  School: Maybe little more attention with red
  11. Parent: Nothing he is blind.  School: No noticeable change in affect.  We do use tin foil on some symbols, but also couples with noise.
  12. Parent: He looks upward to fans and up to light. School: No change in behavior.
  13. Parent: Yes.  School: If he is trying to use vision he will put his face on object to see it.
  14. Parent: Things that move.  School: Team is undecided.
  15. Parent: He leans to turn right to listen to things.
  16. Parent: No.  School: Maybe red
  17. Parent: No. 
  18. Parent: Straight. School: No regular correlation.
  19. Parent: Does not he is blind.  School: He will reach out and touch it.
  20. Parent: No.  School: Items on left side, light underneath.
  21. Parent: No.
  22. Parent: He is blind.
  23. Parent: None he is blind.
  24. Parent: Remember he is blind.
  25. Parent: He has no favorite objects or toy

Who is the CVI Web Exercise for?

This exercise is intended for use by special education caseworkers who evaluate children’s educational needs using the Christine Roman-Lantzy CVI Range Assessment, such as: Teachers of Students with Visual Impairments (TVIs), Certified Orientation and Mobility Specialists (COMS), and Occupational Therapists (OTs). This exercise can also be informally used as an information resource for parents of children with CVI, or anyone else who has an interest in the subject matter.

How many parts does the CVI Web Exercise include?

The CVI Web Exercise contains three parts:

  1. Introduction to CVI and Christine Roman-Lantzy’s CVI Range (videos, documents)
  2. Assessment simulations (videos, documents)
  3. Real-life intervention ideas (videos)

What materials do I need to complete the CVI Web Exercise?

The goal of this exercise is for you to practice using Christine Roman-Lantzy’s methods to evaluate educational needs of children who have cortical visual impairment.

These methods are explained in the book Cortical Visual Impairment: An Approach to Assessment and Interventionby Christine Roman-Lantzy. We will use forms and worksheets that are found in this book. TSBVI cannot provide copies of these materials to you. To successfully complete this exercise, you must have your own copy of the book. (http://www.afb.org/store/Pages/ShoppingCart/ProductDetails.aspx?ProductId=978-0-89128-829-9)

How do I complete the CVI Web Exercise?

Follow the instructions in the sections below to complete the web exercise.

Introduction to CVI

Read the document Introduction to Cortical/Cerebral Visual Impairment.

Watch all of the videos on the Introduction to CVI page (14 videos-82 minutes)

CVI Case Studies

Print all of the documents on the C V I Case Studies page (7 documents)

Watch video Introduction to Case Studies (This explains how to complete the case studies)

Watch videos and complete forms for Brandon – Phase 1 (13 videos – 75 minutes)

Watch videos and complete forms for Cassie – Phase 2 (13 videos – 75 minutes)

Watch videos and complete forms for Ian – Phase 3 (13 videos – 75 minutes)

Intervention

Read document: Materials Used in Intervention Videos

Read document: https://strategytosee.com/strategies-for-students-with-cortical-visual-impairment-handout/

Watch video Intervention Overview (1 video – 6 minutes)

Watch videos for Phase 1 Building Visual Behaviors (9 videos – 13 minutes)

Watch videos for Phase 2 Integrating Vision with Function (8 videos – 12 minutes)

Watch videos for Phase 3 Resolution of CVI Characteristics (7 videos – 11 minutes)

Watch videos for Intervention Task Analysis (6 videos – 17 minutes)

Watch video Intervention Summary (1 videos – 2 minutes)

Additional web training materials on CVI:

Perkins Webcast: Cortical Visual Impairment and the Evaluation of Functional Vision with Dr. Christine Roman.

Strategy To See: For those who care for and work with students with brain damage related vision loss.

American Printing House for the Blind Inc., CVI Website

CVI Training Materials from the West Virginia Department of Education

Go to Perkins Webinars and look for:

  • Cortical/Cerebral Visual Impairment (parts 1 and 2), presented by Barry Kran, O.D., F.A.A.O., Luisa Mayer, Ph.D., M.Ed., and Darick Wright, M.A., CLVT, COMS.
  • Using an iPad for Vision Stimulation presented by Laura Campaña, Director of Infant & Early Childhood Program at Junior Blind of America. Building Strategies
  • Around CVI Phases presented by Ellen C. Mazel, Cortical Visual Impairment Advisor for CASE
  • Collaborative Strategies for Improving Literacy Skills in Students with CVI presented by Diane Sheline, Certified Low Vision Therapist.

This is an exciting area and we are learning new information about the brain continually. Please contact Lynne McAlister or Sara Kitchen with any observations or additions to this course- we would love to hear from you!

Credits

Introduction and Case Study documents and videos written and presented by Lynne McAlister and Sara Kitchen Educational Consultants - TSBVI Outreach

Intervention materials written and presented by Diane Sheline, Independent Consultant out of the Houston, Texas area, CTVI, CLVT, www.StrategyToSee.com

with Diane Sheline, Independent Consultant,CTVI, CLVT.  www.strategytosee.com

Diane: I would like to say again how important it is for early diagnosis and intervention to occur particularly with infants and toddlers functioning in Phase 1.  The idea that our brains are not hardwired but can be strengthened when encouraged is extremely important here.  When there's careful assessment and use of correct strategies and techniques which encourage use of vision, we are often able to see improvement in how the child uses his vision.  Therefore, they are better able to develop, learn, and make progress in the educational environment.  I'd like to thank all of my students, their parents and caretakers, and my colleagues for their suggestions, time, and patience giving me the opportunity to learn about what works with this great group of kids.

with Diane Sheline, Independent Consultant, CTVI, CLVT.  www.strategytosee.com

Diane: Imagine you're working with a young man in a high school life-skills class.  He is cortically visually impaired secondary to an anoxic incident.  He is functioning in Phase 3 and he still has difficulty with visual field preferences, difficulty with visual complexity, and difficulties with distance feeling.  His classroom teacher has calendar time every morning at the start of the day.  Here is what her bulletin board area looks like, and where she instructs from.

[Video Clip]

(In the background) 
Woman: You scared everybody. [laughs]  Do you want me to get that off you?
Man: No, I'm trying to...

[end Video Clip]

In this busy life-skills classroom, calendar time is often noisy and there is movement and activity.  The bulletin board is full with a variety of visual targets, creating a great deal of visual clutter, making it difficult for the student to know which section to attend to.  He is often seated far away from the board, which has the effect of creating additional visual clutter because of the surrounding classroom items and students.  Bringing the student's seat close to the bulletin board will be helpful in this situation, but as important, will be positioning, angling the seat to favor the student's best field of view.  Using a large black frame made out of heavy construction paper or black foam board will help to guide the student as to where to look.  If the frame does not immediately help him to locate the target of interest, give the frame a shake, then re-frame the area of visual interest.

with Diane Sheline, Independent Consultant, CTVI, CLVT. www.strategytosee.com

Diane: Imagine you're working with a 5-year-old who has CVI secondary to hydrocephalous.  This little girl is in a regular kindergarten classroom setting with support.  The CVI characteristics she still has difficulty with are: visual field preferences, difficulty with visual complexity and difficulties with distance viewing.  She is still attracted to light but can be redirected to other visual targets.  She is functioning in Phase 3.  The classroom teacher is working with her on matching plastic block letters to the print equivalent.  Here is a short clip showing her classroom setting.

[Video clip]

This student faces several visual challenges in her classroom setting.  She is seated near the door, which allows light to shine on work surfaces.  While she is no longer distracted by light, she is bothered with glare, which reflects off her table.  Her table and tote tray are both blue, the same as the letter she is supposed to be working with.   There is limited color contrast.  The letters do not stand out, and the tagboard with printed letters blends in with the table.  The work space is cluttered and it is difficult for this student to locate even the first letter she is supposed to match.  Her assignment is made more difficult since she has a lower visual field impairment and all of the letters are flat on the surface of the table.

This student might benefit from eliminating the complexity in the array, thus allowing her to focus on the target of interest.  Only two to four targets are presented at a time, and there is good spacing between targets.  Supplementary lighting has been provided which shines on the task, not in the student's face.  This generally encourages focused visual attention to the task or the target.  Due to this student's lower visual field impairment, an All-in-One board is used at an angle, which brings the task up into her usable visual field.  Using red letters against the black Velcro compatible material creates good color contrast.  The Invisiboard behind the All-in-One board blocks off  distracting movements of other students, as well as visual clutter from bulletin boards, desks and other materials in the classroom setting.  The black mat on the table surface also helps to create contrast.