1. Presented by Cynthia White-Botello, Ms Ed ATOM 2016
So we have this kid with a visual impairment, what does my team need to know?
Presented by Cynthia White-Botello, Ms Ed
ATOM 2016

2. Session Objectives Introductions
Your Local Teacher of the Visually Impaired (TVI)
Required Vision Assessments
Cortical Visual Impairment (CVI)
Optic Nerve Hypoplasia (ONH/SOD or de Morsier’s Syndrome)
Where to go for more information

3. Functional Vision Assessment *unless child is completely blind
Functional Vision Assessment includes information on visual reflexes, appearance of the eyes, corrective lenses, reception and perception of visual stimuli (light), muscle balance, eye preference/behavior, field of vision, depth perception, figure ground perception, light sensitivity, contrast sensitivity, acuity, visual motor coordination, glare, lighting, color & contrast, visual clutter and information on the diagnosis
Anthony, T., D’Andrea, FM., Farrenkopf, C “Looking to Learn” Chapter 2
Distance and size of pictures

4. Learning Media Assessment
Includes information on the child’s use of sensory channels to promote learning
selection and identification of primary and secondary learning media
Supports the development of literacy and learning (including communication)
Anthony, T., D’Andrea, FM., Farrenkopf, C “Looking to Learn” Chapter 2

5. Teaming
“Working as an educational team to help prioritize goals and then generalize skills into multiple environments is critical to successful educational programming.” Related service providers, parents and teachers....”working together to address educational priorities and develop quality instruction throughout the school and home environment is tantamount to success for our children.”
(“SLK Guidebook and Assessment Forms” by Millie Smith, 2005)

6. “Building a relationship based on trust is the single most important aspect of facilitating learning for students with visual impairments and students with visual and multiple impairments.” “SLK Guidebook and Assessment Forms” by Millie Smith, 2005

7. CORTICAL VISUAL IMPAIRMENT and VISUAL PERCEPTION
Visual perception is the ability to see and interpret (analyze and give meaning to) the visual information that surrounds us.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

8. Cortical Visual Impairment (CVI)
This condition refers to the inability of the brain to process visual information that is provided by the ocular system. CVI can be paired with an ocular impairment, or it can be found all alone.
In CVI, the eye is gathering visual information and sending it to the brain for processing, but somewhere along the pathway the information gets lost or diverted. Like a train smoothly rolling down the tracks when suddenly it comes upon a mass of tangled tracks. The train stops because it cannot proceed until the tracks are laid smooth and straight again.
We are the railroad workers who help straighten out the track and show the train which way to travel.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

9. Cortical Visual Impairment Resolution
Exerted from text book, Cortical Visual Impairment by Christine Roman-Lantzy
In children with CVI, some degree of vision is almost always present and there is an expected prognosis of continued improvement in visual recovery.
The plasticity of the brain and its ability to recover from significant injury to the visual centers of the brain is responsible for this continued improvement in visual recovery.
The period of greatest plasticity for visual development in children is between birth and age 3, but occurs up to 10 years. Personal experience has shown that it can even occur years later.
NEVER PLACE LIMITS on the ability of your student to improve.
Research on brain plasticity
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

10. How is CVI Identified and Diagnosed?
Factors involved when considering CVI:
Normal or near normal eye exam– because CVI is attributable to brain rather than eye dysfunction, often children have normal pupillary findings.
History or presence of Neurological problems
Unique visual behaviors – presence of behavioral responses to visual stimuli that are unique to CVI
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

11. 10 Characteristics of CVI
1. Color: preference for a specific color
2. Movement: need or preference for movement
3. L a t e n c y: delayed response when looking at objects
4. Visual Fields: visual field preferences
5. Complexity: difficulty with visual complexity
6. Light-gazing and/or non-purposeful gazing
7. Distance viewing: distance vision impaired
8. Visual Reflexive Responses: visual blink reflex is absent or impaired
9. Visual Novelty: preference for familiar objects
10. Visual Motor: impaired visually guided reach
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

12. 1. Color: preference for a specific color
Often the preferred colors are red and yellow.
Children may also pick up a patterned color.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

13. 2. Movement: need or preference for movement.
Adding light to objects can make them appear to have movement.
Always shine a light from behind a student’s shoulder.
Objects that light from within may also provide stimulus.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

14. 3. Latency: delayed response when looking at objects.
Observe response time from when an object is presented until the student turns to look at the object.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

15. 4. Visual Fields: visual field preferences.
Tunnel vision
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

16. Recker, D. , & White-Botello, C. (2016, Ocotber 12)
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

17. Some things you see, some things you miss.
Visual field difficulties can also be like trying to see through Swiss cheese.
Some things you see, some things you miss.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

18. 5. Complexity: difficulty with visual complexity.
One item, in preferred color, on a contrasting background makes it much easier to locate and view the object.
Same object on a non-contrasting background that is very busy. This makes the object difficult to locate, even with good vision.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

19. 6. Light-gazing and/or non-purposeful gazing
Light is a very powerful source
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

20. We can harness the power and pull of light by using it
We can harness the power and pull of light by using it. The Lightbox provides the means.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

21. 7. Distance viewing: distance vision impaired
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

22. 8. Visual Reflexive Responses: visual blink reflex is absent or impaired
A. Observe initial blink reflex by touching your finger on the bridge of the student’s nose, directly between eyes.
B.  Observe threat response by quickly moving your open palm toward student’s face, but stop short of their nose.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

23. 9. Visual Novelty: preference for familiar objects
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

24. 10. Visual Motor: impaired visually guided reach
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

25. Three Phases of CVI
The CVI Range is completed by the TVI in the Functional Vision Assessment and determines the current visual functioning of a student.
The information needed to complete the CVI Range is varied and takes time for the TVI to complete and calculate. These scores are very important because they are used with the CVI Resolution chart to develop goals.
The themes of Phases I, II and III, which broadly indicate the level of CVI experienced by the student, guide the development of the student’s long-range goals.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

26. Phase I – students in this phase require environments without visual or auditory distractions.
In Phase I, the goal is building consistent visual behavior for children who barely use their vision at all, except in the most controlled situations.
Characteristics of Phase I:
Dominant color preference
Objects need to have strong movement qualities
Require significant wait time, even with familiar objects
Recognize familiar objects and may ignore novel objects
Need a clean, simple background
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

27. This book was developed for a particular Phase I student who preferred green and yellow, but would attend to red. A flashlight was used to draw his attention to the objects.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

28. Phase II: Student in this phase can maintain visual attention in environments with a small degree of visual and auditory competition.
In Phase II the goal is integrating vision with function.
Characteristics of Phase II:
More consistent eye-to-object contact with favorite colored objects
Begin to look at objects with 1 to 2 additional colors
Simple patterns can be included.
Able to maintain visual contact with low levels of familiar background sounds
Able to maintain visual contact while using the sense of touch
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

29. Typical classroom which makes it difficult to use vision.
Using a single colored cloth removes much of the visual clutter and encourages visual functioning.
Some ducks are more visually complex than others.
Simply turning them backwards removes much of the visual clutter, making them more visually accessible.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

30. Phase III: Students in this phase can locate objects in typical or non-adapted settings.
In Phase III the goal is to facilitate the resolution of the CVI characteristics that remain active and that affect the student.
Characteristics of Phase III:
Difficulties with complexity in two-dimensional materials
Difficulty with visual complexity
Difficulty with distance viewing, especially in unfamiliar indoor and in outdoor areas, most commonly in the lower fields.
Difficulty with visually guided reach when the object is very small or against a complex background.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

31. Even items in some preferred colors can continue to be difficult on complex backgrounds.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

32. When introducing new material, it is best to back up a Phase
When introducing new material, it is best to back up a Phase. The characteristic of novelty is important. If the student is functioning at Phase III, introduce new things as if they are operating at Phase II. This will make the new learning easier and generate better and quicker results.
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

33. Where to go for more information..
Teacher of the Visually Impaired (TVI)
IESBVI website (procedures in Iowa)
Visual Impairments General:
Perkins School for the Blind
Paths to Literacy
Teaching Students with Visual Impairments
Literacy for Children with Combined Hearing and Vision Loss
Cortical Visual Impairment (CVI)
Cortical Visual Impairment by APH
Strategies to See
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture

34. Important Things to Consider for kids with Visual Impairments
Touch and hands on learning Tactile strategies Communication Relationship Pacing Teaming Informal Observation – impeccable observer

35. Interacting with the Hands & Body
Use Tactile Strategies such as mutual tactile attention, tactile modeling, and hand under hand techniques
Watch the child’s hands and learn to read how s/he uses them
Think of hands as initiators of topics in conversational interactions, particularly with children who do not yet use words.
a few words about the hands and the importance of relationship with our most challenged learners…..Frequently we take too much control of their bodies without asking consent, giving a choice, some kind of notice, giving them the right to have a choice about their participantion. For all childrne the right to feel safe is CRITICAL for children with complex disabilites who have little sensory access to their environment it is CRITICAL we consider how our touch/smell communicates – promotes a positive relationship

36. Questions, Comments, Thoughts?
Recker, D., & White-Botello, C. (2016, Ocotber 12). Cortical Visual Impairment 101. Lecture