What’s Going On with Cortical Visual Impairment (CVI) in Texas and Beyond

Authors: Sara Kitchen, VI Education Specialist, Outreach Program, Texas School for the Blind and Visually Impaired (TSBVI)

Keywords: cortical visual impairment, CVI, Sensory Balance, Sensory Balance Approach, Communication Matrix, Texas Sensory Support Network, TxSSN, Active Learning, CVI Scotland, Augmentative and Alternative Communication, AAC, Teacher of the Deaf and Hard of Hearing, ToD/HH

Recently Created Tools to Support the Learning Needs of Students with Cortical Visual Impairment (CVI)

Sensory Balance: An Approach to Learning Media Planning for Students with CVI (2020)

Created by Christine Roman-Lantzy, Director at Pediatric View, and Matt Tietjen, Education Consultant and Teacher of Students with Visual Impairment, Sensory Balance is a framework for understanding the learning media needs of a child with CVI. Children with CVI may or may not be able to access their vision at any given time, depending on conditions that interfere with their ability to process visual information. Once an appropriate assessment of visual skills has been performed, such as the CVI Range outlined in Cortical Visual Impairment: An Approach to Assessment and Intervention (Roman-Lantzy, 2018), the best conditions in which a student is able to use their vision can be determined. Individuals with CVI move along a continuum of visual development that begins with learning to look and approaches and/or ends with looking to learn. Throughout this continuum, individuals must have access to meaningful, accessible information while they build neural connections within the visual system. To ensure this happens, a team must provide information that makes use of sensory channels that the student can currently and comfortably access as well as supply intentional intervention to foster visual abilities.

From the authors:

“Students with CVI have educational needs that are unique and often distinctly different from those of individuals with ocular forms of visual impairment. “Sensory Balance” refers to the combination of a person’s sensory learning modalities that results in the most efficient, comfortable access to the world. The goal of the Sensory Balance Approach is to make learning media decisions that meet the child’s current needs and to also ensure that there are regular, intentional opportunities to develop vision into a more reliable way of learning about the world. The traditional Learning Media Assessment (LMA) is considered best practice for children with ocular visual impairments. When performing the LMA process for children with CVI, evaluators need to consider the unique factors of CVI and apply the results through a CVI-conscious lens—which is found in the Sensory Balance Approach (SBA).”

Cover of the front of the Sensory Balance publication by Christine Roman-Lantzy and Matt Tietjen

Augmentative & Alternative Communication (AAC)/Cortical Visual Impairment (CVI) Matrix: Student-Centered Guidelines for AAC & Expressive Communication Development (2020)

This is an instrument for professionals and families to balance the results from the Communication Matrix and CVI Range assessments. It is the product of a joint effort between two CVI Range Endorsed individuals, Jennifer Willis, Teacher of the Deaf and Hard of Hearing (ToD/HH) of Connections Beyond Sight and Sound, and Christopher Russell, TVI, of the New York Deaf-Blind Collaborative. Even when a team has a good grasp of a student’s need for visual modifications and their communication needs, it can be difficult to put those together to create a communication system that works for that student. Willis and Russell combined Charity Rowland’s Communication Matrix and Christine Roman-Lantzy’s CVI Range to provide a way to understand how vision fits into a child’s communication system and learning style. From the authors:

“​​We want to create a match between what is appropriate visually and what is appropriate for the child’s current expressive communication and concept development. This is a ‘balanced’ expressive communication plan.”

This is particularly important as we gain an understanding of which sensory channel must take the lead in any given activity, as considered in Sensory Balance (Roman & Tietjen, 2020), described above. A child who has not yet developed symbolic communication may continue to use objects, behaviors, or other concrete means to communicate their wants and needs. As communication becomes more intentional and more concepts are stored in the child’s memory, that child may communicate about non-present objects and people outside of the activity, using more abstract forms, such as tactile symbols or 2-dimensional images if the vision has also developed to this point. Communication presents difficulty and frustration for many of our students. We must endeavor to choose the sensory channel that is most accessible for them to use when communicating. Pairing a less accessible channel with a difficult task like communicating often causes students to become unduly fatigued, frustrated, or to shut down.

Chris Russell and Jen Willis presented on the use of this tool during a TSBVI Coffee Hour on January 10, 2022. There is a recording of the training on the TSBVI website.

CVI and Active Learning

As we examine which sensory channel must take the lead for meaningful, accessible instruction to occur, the role of Active Learning becomes increasingly apparent for many students who have CVI and are developmentally young.

Millie Smith explained that children who are working in Piaget’s sensorimotor stage use touch and vision as their primary sensory systems; the auditory system cannot be primary for these students: “During the sensorimotor stage of development, the auditory channel cannot be primary because sensorimotor learners are not yet sophisticated users of language, and environmental sounds have no meaning unless their sources are seen and touched.” (Smith, p. 124).

It’s very important that all young or developmentally young people have opportunities to independently experience the world by tactually interacting with everyday items of interest. Doing something independently means not only engaging in the task physically without help but also without a prompt from another person. When a self-directed activity is repeated enough times, it not only becomes understood by the child, but the child builds and refines motor skills. This also helps the child acquire the foundational experiences needed for remembering, classifying, sorting, and labeling. When designing activities for children with CVI who require Active Learning techniques to understand the world, modifications and strategies depend on the instructional focus of the task.

From Active Learning Space:

“Many children with significant multiple disabilities also have cortical visual impairment (CVI), and thus the question often arises about how to adapt Active Learning materials and an Active Learning approach for these learners. It is important to remember that not all sensory areas are addressed during a single activity, and thus vision may be the emphasis during one activity, but then fine motor skills may be the main focus in a different activity. This means that, for example, if a child with CVI is in a Little Room, this might be overwhelming from a visual perspective, but the emphasis during that particular activity might be on reaching and grasping, comparing objects, and crossing midline. During another time, the emphasis might be on vision, and during that time, the use of a black background, spotlighting, minimizing visual clutter, and using familiar high-contrast materials in a child’s preferred color might be the best approach. The team should discuss which priorities to focus on during specific tasks and activities in order to decide how best to arrange the environment at a given time.”

Please visit the CVI section on Active Learning Space under the Implementation Tab.

The new Active Learning Space website has a new logo.

Strategy to See, a website of information on CVI by Diane Sheline, offers some great ideas for tasks that build visual skills and are modified for Active Learning. She shows how to inexpensively create modified learning materials so that early learners can build visual skills by acting on objects in their environment. Examples include the illumi-spring, which is often used in the CVI Den, a beaded curtain that can be placed over a lightbox, and a CVI-friendly book. Please go to her website for countless great ideas regarding intervention for students who have CVI or see the 4th edition of her book, Strategy to See: Strategies for Students with Cerebral/Cortical Visual Impairment (2016).

CVI Statewide Project TxSSN

Texas School for the Blind and Visually Impaired (TSBVI) and the Texas Sensory Support Network (TxSSN) paired to create a book study for Education Service Center (ESC) Vision Specialists in the twenty educational regions in Texas that support best practices in public education. This book study covers all the chapters in Dr. Christine Roman’s 2nd edition of Cortical Visual Impairment: An Approach to Assessment and Intervention. Roman and Tietjen’s Sensory Balance: An Approach to Learning Media Planning for Students with CVI makes up the last module of the study. These two publications pair nicely to provide tools for a comprehensive Functional Vision Evaluation and Learning Media Assessment for students with CVI. ESC Staff have the opportunity to interact with the forms provided within these two resources with a case study student in mind, as well as to discuss and process important points with peers online as they read the material and use the forms.

For assistance with using Sensory Balance to support your Learning Media Assessment for a student with CVI, please contact your region ESC VI specialist.

CVI Trainings in Texas and Online

TSBVI Outreach Coffee Hours

Go to TSBVI Outreach Coffee Hour to register for or to access recorded sessions of TSBVI Outreach’s Coffee Hour discussions and trainings. Past Coffee Hours on CVI include:

Literacy Considerations for Individuals with CVI, with Judi Endicott. Part 1: May 27, 2021. Part 2: October 4, 2021.

Cortical Visual Impairment: Considerations for Augmentative & Alternative Communication Development, with Jen Willis & Chris Russell. January 10th, 2021.

CVI Connect: Technology & Accessibility Considerations for Students with CVI, with Stephanie Steffer. Part 1: February 7, 2021. Part 2: April 11, 2021.

CVI Scotland, with Helen St. Claire Tracy and Gordon Dutton. May 16, 2021.

CVI Study Groups

Four CVI Study Groups are scheduled every year. This year they were scheduled for September 30 and December 2 in 2021, as well as on January 27 and March 24 in 2022. These sessions were not recorded. Self-selected participants/teams share documents and videos regarding their own students with facilitators in advance of the study group sessions. During the sessions, all participants view the shared information regarding specific students and have the opportunity to discuss the students and situations observed and offer suggestions for the community of professionals and parents who attend. Sessions may also center around topics and resources related to CVI as identified by the group. If you missed the CVI Study Groups this year, check back using the link above. They will continue during the 2022–23 school year, with dates still to be determined.

References

Active Learning Space Website: activelearningspace.org

Roman-Lantzy, C. (2018). Cortical visual impairment: An approach to assessment and intervention. Louisville, KY: American Printing House for the Blind.

Roman-Lantzy, C. and Tietjen, M. (2020). Sensory balance: An approach to learning media planning for students with CVI. Watertown, MA: Perkins School for the Blind.

Russell, C. & Willis, J. (2020). Augmentative & alternative communication (AAC)/cortical visual impairment (CVI) matrix: Student-centered guidelines for AAC & expressive communication development. Retrieved from https://1kru3o1eyt4f2w3qy21ds14w-wpengine.netdna-ssl.com/wp-content/uploads/2021/07/aac-cvi_matrix_final_9.9_2.pdf

Sheline, D. (2016). Strategy to see: Strategies for students with cerebral/cortical visual impairment (4th ed.). Retrieved from https://strategytosee.com/

Smith, M. (2014). Sensory efficiency. In Allman, C.B. & Lewis, S. (Eds.), ECC essentials: Teaching the expanded core curriculum to students with visual impairments (p.124). Louisville, KY: American Printing House for the Blind.