The Texas CVI Initiative

Authors: Lynne McAlister and Sara Kitchen, VI Education Specialists, TSBVI Outreach Programs

Keywords: Cortical Visual Impairment, Cerebral Visual Impairment, CVI, Neurological Visual Impairment,, Christine Roman-Lantzy, CVI Range, assessment, intervention, online learning, professional development, Texas Sensory Support Network, TSSN, CVI Web Course

The Texas CVI Initiative: Web-based, Self-Paced Training Coming Soon!

Cortical/Cerebral Visual Impairment (CVI) is a leading cause of visual impairment in the western world. Understanding and evaluating CVI can be complicated because it involves how vision is processed in the brain. Since everyone’s brain is unique, CVI manifests differently in each individual. Teachers of Students with Visual Impairments (TVIs) and Certified Orientation and Mobility Specialists (COMS) may have received little to no training about neurobiology, the visual processing systems in the brain, and how these systems work with one another. If a practitioner does not have a sense of how these systems work, it is very difficult to recognize when these processes are absent or atypical, as in the case of someone with CVI. Although current university students tend to receive more training about CVI than those in the past, this topic, like the brain itself, is complex. As the knowledge in the field of visual impairments increases, we have a mandate to update instruction and improve skill acquisition for new and experienced teachers.

According to the 2019 Texas VI Registration, a statewide annual registration of students with visual impairments, 1,936 students were identified as having CVI in the state of Texas. Texas School for the Blind and Visually Impaired (TSBVI), in conjunction with Diane Sheline (Perkins-Roman CVI Range Endorsee), Texas Tech University (TTU), Stephen F. Austin University (SFA), Educational Service Center professionals, and several ophthalmologists have formed a coalition called the Texas CVI Initiative aimed at increasing knowledge of CVI in our state. The project receives funding through the Texas Sensory Support Network (TxSSN) https://www.txssn.org/.

There are many schools of thought about CVI and its manifestations and intervention techniques. This is not surprising given the incredible complexity and uniqueness of the human brain. Our group decided to focus on the information that would be most useful and immediate for established and/or aspiring teachers of students with visual impairments. We decided to focus on the only CVI-focused assessment currently available that has been peer reviewed, tested, and found reliable: the CVI Range developed by Dr. Christine Roman-Lantzy. In Roman-Lantzy’s 2018 publication, Cortical Visual Impairment: An Approach to Assessment and Intervention (2nd edition), the author takes the reader through familiarization of the characteristics of CVI and provides a thorough assessment process that leads to specific individualized interventions that can be applied in both school and home settings. Teachers often have mandated staff development requirements that allow little freedom for self-study. It may be difficult for them to find the time to read and process an informative text like Dr. Roman’s, much less practice the process in a safe environment where a misunderstanding of the material won’t lead to problematic outcomes for students. It has been identified that this type of experience is needed for new as well as many seasoned TVIs.

As a group entrusted to support TVIs in Texas, the Texas CVI Initiative strives to provide teachers with experience in recognizing CVI characteristics, correctly completing each step of an assessment process (The CVI Range) and, using those results, implementing appropriate interventions that will lead to increased student success. One of the ways we are doing this is by creating an online learning opportunity called the “CVI Web Course.”

The CVI Web Course will consist of three online modules that give in-depth information about conducting the CVI Range on three students. Students were chosen whose CVI Range scores fell within each of three phases of CVI identified by Dr. Roman:

• Phase I-Building Visual Behavior
• Phase II-Integrating Vision with Function
• Phase III-Refinement of CVI Characteristics

Each self-paced module introduces participants to a student, provides their real-life parent interview answers, shows videos of the student participating in their individual educational settings, and then shows videos of their direct assessment. Participants will be provided with an observation sheet to collect and record data gathered from these three sources. Trainees are encouraged to follow along by scoring their own copy of the CVI Range and by comparing their conclusions to the modules. Intervention ideas for each of the students are also provided. Trainees are required to purchase Cortical Visual Impairment: An Approach to Assessment and Intervention by Roman-Lantzy, C.  A. (2018), 2nd Edition, New York: American Foundation for the Blind. You may order this book from the American Printing House for the Blind (APH) https://www.aph.org/product/cortical-visual-impairment-an-approach-to-assessment-and-intervention-2nd-edition/ or contact Sarah Bush at APH (502.899.2306). Some copies are also available on Amazon.

Trainees will not be evaluated based upon their attempts to score the CVI Range. There will be ungraded quizzes within the modules to check for understanding and a test at the end of each, which must be passed to earn Continuing Education Units (CEUs). The intent is to provide those who are unaware or unsure of the assessment process an opportunity to follow along and watch an experienced evaluator (in these case studies, that is Diane Sheline, who is a Perkins-Roman CVI Range© Endorsee) score the CVI Range. The three modules not only give participants three opportunities to solidify their skills and practice using the CVI Range, but will also provide exposure to the diversity in the use of functional vision in individuals with CVI. These modules are designed to coordinate with and prepare for Dr. Sandra Newcomb’s course, “Assessment of Students with CVI: Reliable Scoring of the CVI Range”, which is currently offered through the Perkins School for the Blind.

These online learning opportunities, plus experience in evaluating individuals with CVI, can adequately prepare someone seeking The CVI Range Endorsement©.

Following the process outlined in each of these classes will help professionals:

• Understand more about CVI
• Be able to apply that knowledge to their specific students.
• Be empowered to more confidently guide the student’s team to apply appropriate interventions for each interfering CVI characteristic across the school day as well as in the home.

These classes will be free of charge and may be accessed by any interested individual including family members, support staff, and medical professionals.

The CVI Web Course is being Beta-tested by experienced TVIs, colleagues without training in visual impairment, and students at SFA and TTU who are learning about CVI.  Data will be gathered from these individuals and applied to create the final product. It is projected to be available for use by the end of 2021.

CVI is a complicated issue. The mechanism of sight involves myriad areas of the brain.  These areas contribute different information about what a person is seeing and interacting with and shares that information with almost immediate precision. Any interruption in this robust integration can result in decreased functionality which can vary from only affecting a few visual aspects, such as color perception or facial recognition, to creating a condition that results in functional blindness. Because the brain can relearn skills impacted by some form of damage (neuroplasticity), it is vital that families and professionals know what specific environmental modifications help their child more easily use their vision. If these modifications are used consistently, children will have more opportunities to practice seeing, and through practice hopefully increase their vision. The CVI Range will isolate interfering visual characteristics, and Dr. Roman provides intervention suggestions and resources to aid the child’s team when creating appropriate environments. It takes time and study to learn how to administer the CVI Range using only the Roman-Lantzy book. Time is unfortunately a luxury many educators and support staff do not have. It is our hope that the TSBVI CVI Courses will serve as complementary resources to the Roman-Lantzy book and expedite educators’  knowledge of CVI characteristics and how they may manifest in each Phase. These courses can also help them conduct the CVI Range assessment correctly and increase teacher confidence and competence as they implement appropriate interventions.