CVI Symposium Ellen Cadigan Mazel M.Ed., CTVI Perkins School for the Blind May 2015 Todays Goals Discuss CVI Discuss the evaluation of CVI Discuss theories and assessment: Dr. Roman Lantzy and Dr. Gordon Dutton Todays Goals CVI assessment and strategies for older students. Considerations with increased age? Improvements expectations with increased age? CVI: All in the Brain Damage to the visual cortex Damage to the visual pathways Both Child can not process or understand visual information. Cortical visual impairment is the leading cause of visual impairment in children. CVI Rethinking Consider assessment and strategies for ocular impairment to be inappropriate for dealing with a child with cortical visual impairment. Dorsal Stream Where is the target? Tells us about the object s orientation in space. Responsible for eye hand coordination. Give us perception of movement. Ventral Stream What is the target? Recognizes: Faces and facial expressions Colors Shapes Writing Objects Statement on CVI August 2008 APH advisory group: provide guidance to develop products for CVI. Dr. Christine Roman-Lantzy and Dr. Gordon N. Dutton and 9 others. Agreement Definition: Brain based visual impairment of visual cortex and/or visual pathways. All children with CVI should be considered visually impaired. Agreement All children regardless of severity of CVI or severity of multiple disabilities deserve vision services. Criteria for CVI Eye exam does not explain the level of functional vision. There is a history of neurological problems. There are distinct behavioral characteristics for people with CVI. Low Vision and Legal Blindness CVI defined: Visual acuity: traditional acuity measures dont work for CVI Visual fields Visual abilities compared to peers Agreement CVI functioning ranges from severe to mild. Screen for ocular problems. Screen for CVI: FVA must be grounded in the characteristics. Agreement: Characteristics Lightgazing Poor visual attention Color preference Restricted fields Difficulties with visual complexity Difficulties with distance Better visual skills with known objects Agreement: Characteristics Attention to moving objects Looking away when reaching Visual latency Atypical blink reflex Looking does not mean understanding. Nearly all children improve but rarely lose the CVI diagnosis. Disagreement Cortical Visual Impairment vs. Cerebral Visual Impairment. Roman: Cortical Visual Impairment CVI and the Evaluation of Functional Vision Definition and Causes Developed an Assessment: CVI Range Roman: Cortical Visual Impairment Strategies and environmental supports Discusses dorsal and ventral stream: building from dorsal to ventral. Ten Characteristics 1.Color 2.Movement 3.Latency 4.Visual Field 5.Complexity 6.Light Gazing 7.Distance 8.Visual Reflexive Response 9.Visual Novelty 10.Visual Motor Ten Characteristics of CVI 1.Color: Does the child attend to certain colors? 2.Movement: Does the child attend to moving materials? 3.Latency: Does the child need a long time to look? 4.Visual Field: Does the child see in one visual field better than in other visual fields? Ten Characteristics 5. Complexity: Visual Complexity Auditory Complexity Positional Complexity Ten Characteristics 6.Light Gazing/Non-purposeful Gaze: Does the child always look towards light/seem not to look? 7.Distance: At what distance does the child see? 8.Visual Reflexive Response: Does the child blink to touch and visual threat? Ten Characteristics 9.Visual Novelty: Does the child like familiar things and seem to ignore new things? 10.Visual Motor: Does the child reach? Do they reach while looking? Do they play while looking? Characteristics on the CVI Range Assessment Remember each characteristic is on a continuum When a child improves with one characteristic, you expect to see improvement in other characteristics. Levels of Severity: Phases of CVI Phase I: 0-3 on CVI Range Phase II: 3-7 on the CVI Range Phase III: 7-10 on the CVI Range Goals in each Phase Phase I: Looking Phase II: Vision plus function Phase III: Resolving characteristics Phase I Case Study Phase II Case Study Phase III Case Study Fluctuating Vision What is fluctuating vision ? Consider the environment. Consider the child. Expecting Improvement Planning Using Assessment Results Base goals on the CVI Phases. Create learning supports around Characteristics. Create strategies and adaptations matched functional vision. Environmental changes support childs needs. There is no Therapy You want an approach throughout the day. You want strategies to support and build vision use. (after assessment). Dutton: Cerebral Visual Impairment Definition and Causes Strategies for current functioning Discusses dorsal and ventral streams. Dutton No mention of strategies for improvement. Created Dutton Survey Dutton Survey 52 questions No mention of Color, Movement, Latency, Light Gazing, Visual Reflexes characteristics. Most concerned with visual field (8) and complexity (33). CVI Across the Ages Consider Brain Science Plasticity Critical periods Potential for resolution with increasing age? Brain Plasticity Using the brain is important: early and often. The brain is most plastic in infancy but studies show some plasticity continues into adulthood and old age. The most plasticity is in the younger years Critical Periods There may be critical periods for certain types of learning. The Mystery of the Brain Assess all students regardless of age. Place learning supports and envronmental in place. Expect improvement. Ten Characteristics 1.Color 2.Movement 3.Latency 4.Visual Field 5.Complexity 6.Light Gazing 7.Distance 8.Visual Reflexive Response 9.Visual Novelty 10.Visual Motor Allie: 19 Years Old Resources Brain Development Whats Going on in There? The Brain That Changes Itself All kinds of kids Ocular Impairment with CVI Any child can have both types of visual impairment. Be aware of both Assess for both Create strategies for both What Can You Do? Learn and share TVIs: Understands the assessment Get an assessment of visual skills: CVI Range Create strategies and environments Expect improvements Assess continually to measure improvements Change strategies based on the new assessment. To Read More: Christine Roman-Lantzy,Ph.D. Jim Jan, M.D. Gordon Dutton, M.D. Lea Hyvarinen, M.D. Mary Morse, Ph.D Resources Cortical Visual Impairment: An Approach to Assessment and Intervention by Christine Roman-Lantzy CVI Perspectives available on quota from APH Dutton CVI Survey Resources American Printing House website: CVI Texas School for the Blind website Perkins Webcasts: Teaching Resources cviteacher.wordpress.com Resources The American Foundation for the Blind: eLearning Center: CVI Focus Webinar 5 sessions $179ductDetails.aspx?ProductId=eCVIfocusSERIES&rulin g=NoCVI: UMASS Boston Vision Studies Program: 3 graduate credits. Online CVI Resources West Virginia Department of Education: Cortical Visual Impairment CVI Symposium The End Ellen Cadigan Mazel M.Ed., CTVI Perkins School for the Blind May 2015 Typical Visual Development Vision develops in an organized developmental way Attention then understanding Lights then objects then people Fixation then shifting then tracking Near then far Peripheral then central Familiar then unfamiliar Parts then whole Simple then complex Large then small