What I've learned about Cortical Visual Impairments

There are two main types of visual impairments: Ocular and Cortical.

Oculare visual impairment

OCI's can often be corrected with the use of glasses. Ocular impairment can be classified by loss of visual acuity and loss of visual field and can cause varying degrees of blindness. This can occur due to damage of the eye or ocular nerves. Blindness is diagnosed when a person has a visual acuity of worse than 20/400 with the best possible correction or a visual field of 20 degrees or less.

Cortical Visual Impairment

CVI's cannot be corrected with glasses. A Corticle Visual Impairment (CVI) is caused by damage to the parts of the brain that process vision. Children with CVI's can be expected to make progress in their visual functioning over time.

There are 10 characteristics of cortical visual impairment. Color preferences, need for movement, visual latency, visual field preferences, difficulty with visual complexity, need for/attraction to light, difficulty with distance viewing, atypical visual reflexes, difficulty with visual novelty, and difficulty with visually guided reach.

CVI's range from 0-10 in 3 phases.

* 0-3 Phase I: Most severe impact on visual functioning

*3-7 Phase II Moderate impact on visual functioning

*7-10 Phase III Closest to typical visual f

unctioning

When working with children with a CVI diagnosis there are many adaptations we make.

finger play cards with puff paint on black felt board

Only 2-3 options

If there is a visual choice opportunity we will decrease the field of options down to two and bring the choices a foot or two away from the childs face.

Two different colored pumpkins on black background

Use Colors

We will also try to make the colors of the choices as different as possible. We may also have an element outlining the choices if they are PECS. Either the child favorite color (Some of our kiddos love hot pink) or red which is a color that children are commonly drawn to as early as infancy.

We might outline song cards with puff paint (Which also adds a texture element). We will outline each choice with the same color in order for each choice to have the same likely hood of drawing the eye and being considered.

It also helps to put options onto a BLACK

background. white kind of fades away, but black will make other colors like red and yellow pop out more and be easier to focus on.

Use Light

We can also stand behind the child with a flashlight to shine light on an object we want them to focus on, like instruments or stuffed animals or anything else we was visual attention on. Shining a flashlight on something shiny can also help with visual attention so using foil paper, sparkle paper or even shiny bead necklaces.

We may also put objects on a light box. Pictures might be more opaque so the colors shine through with the light or it might be a simple outline picture on translucent paper.

Use Movement(to gain attention)

Children with CVI diagnosis may like to shake their heads or the objects the are looking at because movement may cause that object or light to become more interesting to them. It might reflect light differently or blur when moved.

We used Fiber optic lights during an intervention and a lot of our kids found that when you shook the fiberoptic cords on certain colors like white, other colors would show up (Blue, Red, Green in the case of white).

Consistency

If there are common choices that a child has to make and they need the help of visuals to make the choice, it is important at least initially that the objects, pictures or colors used are consistent. If you ask a child with recorded buttons(big mac) or PECS if the want "more" or if they are "all done" you might have two different colored backgrounds but those colors need to consistently be attributed to the same choice(red for all done/green for more). The pictures used for PECS also need to be consistent because it might be hard to attribute the same meaning to different pictures that mean the same thing. You may also be consistent with which side you put the choices on (More on the Left/All done on the Right)

If you have any questions about adapting interventions for children or individuals with a CVI diagnosis, im not an expert but I would be happy to help.

https://lighthouseguild.org/cortical-visual-impairment-cvi/

http://ophthalmology.pitt.edu/vision-impairment/what-vision-impairment