1. By: Julie Kushman Dr. Christine Roman-Lantzy 2007 Stephanie Steffer MDE-LIO State CVI Team

2.  What is CVI?  10 Characteristics  Accommodations/Hands on Experience

3. A Cortical Visual Impairment (CVI) is the delay in processing information from the eyes to the brain. The anatomy of the eyes is typically normal, but there can be an additional ocular loss. Children with CVI must meet the all of the following criteria: normal eye exams or an eye exam that reveals an eye condition that cannot explain the profound lack of functional vision, a medical history that includes neurological damage, and the presence of unique visual and behavioral characteristics. The visual and behavioral characteristics consist of: color preference, latency, visual field preference, complexity, light-gazing, distance, visual reflex, visual novelty, and a visually guided reach. Ninety percent of information processed by the brain is done visually. During infancy, the visual pathway is still developing and therefore vision can improve with consistent function. Although this critical window of time occurs during infancy, it is unknown when this period ends; as a result progress for older students should still be expected but at a slower rate. Dr. Christine Roman's research has shown an increase of visual function to Phase III within 3.7 years. Each student needs materials that match their visual experiences and accommodations to their environments to provide an appropriate intervention.

4.  Unlike the majority of ocular disorders, CVI is a condition in which improvement in vision is not only possible but likely.  At this time the leading cause of blindness in young children is CVI (Noted by the American Printing House for the Blind, keeper of a national census of young blind and visually impaired children in the country)

5.  An ocular condition consists of an imperfection in the anatomy of the eye.  CVI is the processing from the eyes to the brain.  A person can have an ocular loss and CVI.

6. *Eye Exam that doesn’t explain the significant lack of visual function *History of neurological disorders associated with CVI *Unique visual and behavioral characteristics Eye doctors do not always include this piece in their evaluation.

7.  Parents are the true experts when it comes to how their children use their vision.  It is important to communicate with the family for the consistency of the intervention.

8.  1. Questionnaire with the parent: It is important to collect data on how the student uses their vision.  2. Questionnaire with the classroom staff:  Again, we are collecting data on how the student is using their vision.  3. CVI Screening: Trained staff will identify how they are using their vision and what accommodations are most useful.

9.  4. Education on CVI: It is important for everyone that works with the student to understand CVI.  5. Implement Intervention: A report is written and an intervention is created to share with the team/family.  6. Monitoring: VI teacher checks in with the team monthly and an annual evaluation is scheduled. The intervention should be gauged by the progress of the student.

10.  Resolved Characteristics: No longer a factor affecting visual functioning  Visual Latency: Delayed responses in looking at objects  Visual Novelty: Quality of being new  Visual Anchor: Familiar visual target  Visual Array: Arrangement of objects  Salient Features: Noticeable or important characteristics

11.  Complexity  Distance Viewing  Visual Fields  Visual Novelty  Latency  Absence of a Visually Guided Reach  Color  Movement  Light Gazing and Non-Purposeful Gaze  Atypical Visual Reflexes

12.  3 parts  Surface of object (image is difficult to process)  Background (Where’s Waldo picture)  Sensory environment (Auditory distractions)  Items that are complex:  Faces ▪ Multiple hair styles, make-up, facial expressions, we typically talk when close up, wearing perfume  Reflective silver ▪ Shows the color of the rainbow/ multiple colors

13.  Distance adds complexity of array.  This may be why a student is not able to identify an item until they are very close.

14.  Where does the child see best? Most common field is peripheral first then central. Ex: Deer while driving. Typically, a student has a preferred side of vision.  Lower field loss is very common APH Federal Quota Monies Free to VI students

15.  New items are difficult  Parents are a good resource to identify favorite or familiar objects  Example:  Which one would be easier to recognize– your name or random letters? (Julie, LKlJa)  When you ask your husband to find the rice and he says he can’t see it. Sorry guys

16.  Delayed response. Allow plenty of time for the student to process the information. Sometimes it may take up to 2 minutes for the student to look at the item, processes the information, and then give a response. Be patient!  Ex: How long does it take you to pay bills when your child is screaming? Hard to focus, huh?

17.  Look and reach as a separate event. Their brain is processing two things: vision and motor control. Example: when a student sees a raisin, they move their arm towards the item, then turn their head away, and finally tactually search for the raisin on the table. Example: when a student was shooting a basketball, she would look at the hoop, and then turn her head as she was shooting.

18.  Look, look away, and look back behavior:  student may look at an object for a few seconds and look away. If you pay attention, the student may look back at the item. Make sure you are providing enough time for the student to look back at the item before you move it. (1-2 minutes to observe) This is the student telling us that it is difficult to look at the object, but they are really interested in it.

19.  Typically red or yellow are easiest.  If we are unsure then red is the go to color.)  Objects of a single color are easier than objects with multiple colors.  Use the preferred color as a visual “anchor”  The object you want the child to look at should be in their preferred color or outlined in that color.  Example:  Yellow: highlighters, yield sign, and a school bus  Red: stop signs, emergency lights, brake lights.

20.  Movement attracts attention to an item.  Reflective properties: mylar or glitter  Shake/move the object: slinky  Move light on still object:  Students may shake their heads /yoga ball/rock (DO NOT TELL THEM TO STOP!!) Examples:  Rail Road crossing lights  Police lights  Reflective tape on a stair tread.  Break lights on a car  When in a crowed area you waive your arms over your head to get their attention.  Spotlight when in a dark theater

21.  Light gazing is when a student stares at a window or lights.  Non-purposeful gaze may be towards a spinning fan or staring at the TV when a movie is finished playing (White noise)  These are very easy things for the student to look at. Our goal is for the student to look at and process more complex items.

22.  Blink reflex  Cannot be taught, just for testing purposes.  Resolves with other characteristics

23.  Think of the intervention as opportunities for consistent viewing. (1-2 minutes minimum)  The intervention must be incorporated into the existing daily routine.  Communication with home will be important.  Pair vision with reward.

24.  Phase I: Building visual behaviors  Phase II: Integrating vision with function  Phase III: Resolution of remaining characteristics

25.  Single color objects  Preferred color  Objects need movement  Simple items and background  Familiar items  Significant latency (wait time)  Lack of a visually guided reach  May localize on objects Goal: Increase visual attention and build stable and sustained looking. (Roman)

26.  Familiar items to the student  Tri-fold board or black material to reduce complexity.  Preferred color  Reflective tape around objects in daily routine

27. Controlled Environment:  Turn off lights  Simple background  Minimize auditory distractions  Items should be positioned 18 inches or closer.  Avoid positioning the student towards lights when asking to use their vision.  Present items to their preferred side

28.  Student will begin to demonstrate hand-eye- coordination.  Purposeful fixation  Light gazing and non-purposeful gazes should decrease  Introduce new items with characteristics of familiar item  Blink response to touch is present, but inconsistent with blink to threat  May regard familiar faces Goal: integrate vision with function. Students tend to demonstrate more consistent eye-to-object contact with accommodations.

29.  Introduce two-dimensional images towards the end of this phase  Tri-fold board or black material to reduce complexity when needed  Preferred color plus 1-2 colors  Reflective tape around objects in daily routine  Selection of materials are less restricted

30.  Visual attention extends up to 6-10 feet  Background noise is tolerated when using vision

31.  Use vision in performing most tasks and demonstrate visual curiosity  Improvement in viewing two-dimensional images  View items up to 10-15 feet  Visually guided reach with small items  Important to teach sorting skills and salient features.  May regard faces  Uses vision to imitate actions Goal: resolve CVI characteristics.

32.  Remove clutter from two-dimensional images. (cut out picture and put on a simple background. Slowly increase complexity)  Use occluders or window cards  Highlight salient features  Tri-fold board or black material to reduce complexity when in new environments  Bookshare Website: https://www.bookshare.org/cms/get- started/sign  Bookshare App: https://itunes.apple.com/us/app/read2go/id425585903?mt=8 ($19.00)

33.  Practice salient features in unfamiliar environments.  Visual attention extends beyond 15-20 feet. Give the student a sample of what they are looking at

34.  Hiccupping  Yawning  Gaze avoidance, light-gazing  Keeping eyes closed or frequent periods of sleeping.  Facial grimacing  Hand or finger tension  Reflexive laughing/high pitched vocalization

35. Parents  Studies have shown parents of children with CVI indicate high level of accuracy regarding child’s background, history, and performance.  Implements intervention as recommended Classroom teacher  Team leader and coordinator of the IEP team.  Implements intervention as recommended Teacher for the Visually Impaired (TVI)  Screening, report findings, intervention, education on CVI, and on a monthly and annually basis re- evaluates.

36.  Hand out Eye conditions/Medical conditions associated with CVI (See Handout)  Sometimes the child see’s it, and sometimes they don’t.  We don’t know what they can and cannot see.  They appeared to be totally blind when they were younger, but now they are doing better.  The eye doctor said there was nothing wrong with his eyes.

37.  Put Your CVI Hat On!!!

38.  Students with CVI benefit from a visual warm-up just like an athlete does before working out. When presented with a simple visual activity, the student can be more engaged during their lesson.

40.  Complexity: background  Distance Accommodations:  Use a black blanket or tri-fold board  Position the student closer to the lion

43.  Color:  Complexity: background or sensory Accommodations:  choose student’s preferred color  Put the items on a black background. Some students are tactile defensive and may be distracted by the noodles.

46.  Complexity: Object and possibly sensory  Color Accommodations:  Use a black blanket or tape to cover unused areas.  Paint all the keys one color.  Make sure volume is reduced or off.

49.  Complexity: Object- poka dots  Color: Accommodations:  Use a black blanket or tape to cover unused areas.  Paint characters one color or purchase items that have a simple pattern.

52.  Complex: Object: pattern Accommodations:  Use a black piece of paper to cover the pattern or purchase a shape sorter that does not have a pattern.

55.  Complexity: background  Light-gazing: Accommodations:  Close the blinds or position the student with their back to the window.

57. Pay attention to your Calendar. Color Complexity

58. Pay attention to what you are wearing. Pay attention to what is in the background.

59. This is an idea to utilize the student’s preferred color.

61.  Complexity: background and item Accommodations:  Student’s may need real objects. It is easier to look at the real object rather than a picture. You could use a piece of the item, such as a piece of a seat belt to indicate transition to the bus.  Present the items in a row or one at a time to minimize clutter.

65.  Complexity: Array and Sensory  Color: Accommodations:  Minimize the amount of items presented.  Cover walls with black paper so you can’t see through the fiberglass.

67. This is really a Phase II accommodation, but with daily repetition and turning the lights off and using a flashlight it may be considered as a Phase I accommodation.

68.  Reduce the amount of cards that are presented to the student  Highlight salient features in red.  Teach each picture as a lesson.  Ex: Duck: ▪ Two webbed feet ▪ Bill for a nose ▪ Feathers ▪ Two wings ▪ Generalize other ducks

69.  Minimize volume on toys, work in a quiet room, reduce background noise, or have the child wear headphones.  Use tri-fold boards, all-in-one boards, or black felt board.  Prompting: Do not prompt unless you think the student does not understand the directions. Silence is golden!!!!  Single color: paint over complex patterns or be aware of this when making a purchase.

70.  Eraser app to reduce clutter in pictures:  Background Eraser for iPhone By handyCloset Inc: ($0.99)  https://itunes.apple.com/us/app/background-eraser-for- iphone/id437015777?mt=8 https://itunes.apple.com/us/app/background-eraser-for- iphone/id437015777?mt=8  LST Monitor App (My app, release date in fall)  http://www.lifesciencetechnologies.com/Vision http://www.lifesciencetechnologies.com/Vision  Free app on Friday:  http://www.smartappsforkids.com http://www.smartappsforkids.com  Bookshare Website:  https://www.bookshare.org/cms/get-started/sign https://www.bookshare.org/cms/get-started/sign  Bookshare App: https://itunes.apple.com/us/app/read2go/id425585903 ?mt=8 ($19.00) https://itunes.apple.com/us/app/read2go/id425585903 ?mt=8

71.  APH.org (Ask your visually impaired teacher)  Reading Stand  Trifold board  Tactile communication system  Variable Beam Flashlight Kit

72.  Triple home click  Guided access  Use the lock screen/ toggle bar  Inverted colors: FUN/Photphobia/peripheral loss  Voice Over/Speak  Zoom: pinch/expand and three finger double tap.