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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.

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

Diane: The same child that is working on cruising also needs to increase his skills in the area of self-help.  His parents would like him to help with brushing his teeth.  The task would be to reach out and grasp his toothbrush.  This is also an example of integrating vision with function.  This child's bathroom sink area might look something like this.

[Video clip]

This bathroom sink area looks like most bathrooms: there are bottles scattered around, towels covering areas, the toothbrush is a translucent pink that is light in color like the counter, the mirror is big and reflective.  Given of what we know of this student, we could make the following adjustments, which might just encourage looking behavior as well as reaching and grasping behavior.  The mirror is blocked, so that the movement from his reflection doesn't distract him.  The black Invisiboard and mat helps to create contrast.  The toothbrush now stands out.  The red is a favored color for the student and the blinking light-up quality draws his visual attention.  Since he has difficulty locating visual targets when they are in his lower visual field, standing the toothbrush up on end helps bring it into his visual field.  Complexity is reduced within the array.  There are no other

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

Diane: Imagine you are working with a 3-year-old toddler who is cortically visually impaired.  You have a completed a CVI resolution chart, and found that he's functioning in Phase 2, integrating vision with function.  His parents would like to see him start walking.  And he will stand at the edge of the couch, but he has not yet taken his first step.  He is attracted to light, but can be redirected to other targets.  He alerts more quickly when there is slight movement associated with the target, but he is often distracted by the TV and other noise-producing toys.  The orientation and mobility instructor who's working with him would like to get the student to take a first step and to start cruising.  This is the task as we do our CVI Task Analysis.  The O&M instructor would like to integrate vision with function, mobility.  Here is a short clip showing the couch that he might be standing at, and some sample toys on that couch, and what it's like at his home environment.

[Video Clip]

[radio playing]

[end Video clip]

The toys seem to blend in with the couch color.  When sunlight is coming through the windows, he often stares at the windows.  The table light just behind the couch is also a distracter.  The TV is often on in his home, and he attends well and often using his auditory channel.  How can we encourage looking behavior which may help nudge the student into movement?  Let's think of some different strategies as we do a CVI Task Analysis.

We know by looking at our CVI resolution chart that he attends to targets that have light qualities and slight movement.  He does not attend to targets in his lower visual field, so we will need to keep the targets up at eye level.  He has some difficulty with complexity in his sensory environment, so we will need to reduce auditory as well as tactual input when visual learning is taking place.  Since this student seems attentive to lights, we will close the curtains, turn off the table lamp, as those are often a distracter, and use lighted targets or light paring techniques as a way to attract his visual attention.  Since this student attends to targets up to 24 to 36 inches away, we can place visually attractive targets just out of reach to encourage movement.  By modifying his learning environment, he may now attend to visual targets and move towards them.