1. PRESENTED BY THE MICHIGAN DEPARTMENT OF EDUCATION-LOW INCIDENCE OUTREACH CORTICAL VISUAL IMPAIRMENT MENTOR TEAM CHAESA MACWILLIAMS CMACWILLIAMS@TBAISD.ORG NAOMI WELBORN NAOMI.WELBORN@OAKLAND.K12.MI.US CMACWILLIAMS@TBAISD.ORG NAOMI.WELBORN@OAKLAND.K12.MI.US ACCOMMODATIONS AND INTERVENTIONS FOR ALL PHASES OF CORTICAL VISUAL IMPAIRMENT(CVI)

2. MDE-LIO MENTOR TEAM  Established in 2012  Goal of the Mentor Project  Under the direct supervision of Dr. Christine Roman- Lantzy  Dr. Christine Roman-Lantzy author of Cortical Visual Impairment: An Approach to Assessment and Intervention (Roman-Lantzy 2007)  Leading researcher and specialist in Cortical Visual Impairment

3. CORTICAL IMPAIRMENT VS. OCULAR IMPAIRMENT

4. FIELD PREFERENCE “Proper positioning and active movement are essential to increase the child's participation in the environment. Children with both cvi and additional motor deficits expend disproportionate effort on head and trunk control, which can result in decreased visual abilities (gentile, 2002). Many children with decreased trunk or head control require special positioning support so they do not use up their limited focus and energy toward maintaining a safe and upright position. Because of neurological connections between the child's body position, movements, and vision, appropriate and varied movement experiences are essential components to optimizing visual capacity” (baker- nobles, 1995). From: A Team Approach to Cortical Visual Impairment (CVI) in Schools - Donna Shaman

5. POSITIONING/SEATING  Position student with instruction to their dominant side.  Utilize movement to attract attention to objects outside of the preferred field to encourage scanning of the environment  Present materials in preferred field  Initiate activity in preferred field

6. COMPLEXITY  Utilize a solid background behind all materials  Control distance complexity by presenting materials against a single colored background. Use drapes, paper, temporary walls.  Introduce materials when additional auditory and visual stimuli are not present  Limit amount of material presented  Utilize occluders, windows, etc. to block complexity  Wear solid colored clothing, or drape smocks, aprons, etc. over clothes to hide bright colors and patterns.

7. DRAPES TO HIDE CLUTTER http://www.google.com/imgres?imgurl=http://www.lnt.com/photos/product/giant/6070170S9168/-/50-w-x-84-l-curtain- panels.jpg&imgrefurl=http://www.lnt.com/product/panels-drapes-curtains/607017-9137/grommet-jet-black-designer-blackout-curtain- panel.html&h=800&w=800&tbnid=rKnaJqvYZGK4NM:&zoom=1&docid=i_2dCq02kWAroM&hl=en&ei=oWLKVO3MKImpyQSJ7oLQCw&tbm=isch&ved=0CEI QMygRMBE

8. CLASSROOM APPLICATION

9. http://www.bestaprons.com/black-two-pocket-best-selling-cobbler-smock-apron-available-in-four-great-unisex-sizes-item-350-400 / HIDE PATTERNED SHIRTS WITH APRONS OR SMOCKS

10. LOW COMPLEXITY BACKGROUND

11. DISTANCE VIEWING Provide low complexity background to materials Diminish visual clutter and distraction Bring objects in to reduce the amount they become “lost” in the background

12. DIFFICULTY WITH DISTANCE VIEWING WALK SIGN LOST AMID THE BACKGROUND OF A STREET SCENE STREET SIGN IN ISOLATION

13. NOVELTY  Utilize familiar objects  Provide a warm up period with familiar objects before introducing new materials  Select new materials that share salient features of familiar objects

14. MOVE FROM FAMILIAR TO ITEM TO ONE SHARING SALIENT FEATURES

15. SALIENT FEATURES A Salient Feature is something that makes an item uniquely itself. We use these words as adjectives to describe the “ness” of something. Use these features to describe objects in the child’s routine. Then use them to generalize to other objects.

16. NOVELTY ACTIVITY

17. LATENCY  Identify students wait period  Utilize quite wait time for response  Allow additional wait time for new or unfamiliar objects/materials  You may need to use a stopwatch. 10 seconds can feel like an eternity.

18. LET’S DO MATH! 5(15+3) =

20. WAIT!!! QUIETLY

21. ABSENCE OF VISUALLY GUIDED REACH  Provide high contrast background  Utilize items in preferred color against background  Leave object of attention inactive while child locates

22. LOOK VS. LOOK AWAY http://www.google.com/imgres?imgurl=http://cache3.asset-cache.net/gc/461696073-child-reaching-for-merry-go-round-toy- gettyimages.jpg%253Fv%253D1%2526c%253DIWSAsset%2526k%253D2%2526d%253DGzd%25252BnLbZOEe%25252FrMZUC0K9UMYNvL%25252Fz5%25252B7RpUcrz388aSI%25253D&imgrefurl=http://ww w.gettyimages.com/detail/photo/child-reaching-for-merry-go-round-toy-royalty-free- image/461696073&h=338&w=507&tbnid=OiNUcoEHREqqHM:&zoom=1&docid=sNUwJ2bEZeaC0M&itg=1&hl=en&ei=RA7VVJ_JBJCZyASK34HQBg&tbm=isch&ved=0CEcQMyggMCA http://www.google.com/imgres?imgurl=http://cache4.asset-cache.net/gc/115619248-boy-pushing-toy-car-on-kitchen-surface- gettyimages.jpg%253Fv%253D1%2526c%253DIWSAsset%2526k%253D2%2526d%253DxVs5sv6FmXBhuHRAIahvGSEmenO %25252Bmbf2NfitvgrSA87R%25252BqKuXi5f5i5FoMuMXuGs&imgrefurl=http://www.gettyimages.com/detail/photo/boy-pushing- toy-car-on-kitchen-surface-royalty-free- image/115619248&h=338&w=507&tbnid=ud8VJRV7nuAmYM:&zoom=1&docid=xHL3Z_sVWe2Q7M&hl=en&ei=Ag_VVL37Epan yASp4YGoBQ&tbm=isch&ved=0CCgQMygMMAw

23. COLOR PREFERENCE  Introduce materials in the child’s preferred color  Introduce new colors in the presence of the preferred color  Utilize familiar items in a new color

24. BASED ON ASSESSMENT YELLOW RED GREEN PURPLE BLUE

25. NEED FOR MOVEMENT  Movement of an object while held stead in a visual field may be necessary to illicit attention  Utilize objects that are reflective to give the illusion of movement  Apply reflective material to objects to draw attention  Novel items may need movement, where familiar ones do not.

26. CVI REFLECTIVE MATERIALS Appropriate materials demonstrated from our CVI kits against background with flashlight.

27. LIGHT GAZING When child gazes at lights are reports a non-purposeful gaze they often times need accommodations to purposeful items and activities. When accommodations are met for complexity, color preference, etc., gaze can be directed appropriately

30. MDE-LIO CVI TEAM MEMBERS Johanna Anand- MDE-LIO Cindy Barker- Traverse Bay ISD Sue Bradley- MDE-LIO Gary Garn- Eastern Upper Peninsula Chaesa MacWilliams- Traverse Bay ISD Breanne Marcum- Oakland Schools Lynn Pensari- MDE-LIO, Project Leader Tina Smith- Ingham ISD Naomi Welborn- Oakland Schools