Mazel MEd 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 ID: 935166
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Slide1
CVI Symposium
Ellen
Cadigan
Mazel M.Ed., CTVI
Perkins School for the Blind
May 2015
Slide2Today’s Goals
Discuss CVI
Discuss the evaluation of CVI
Discuss theories and assessment: Dr. Roman
Lantzy
and Dr. Gordon Dutton
Slide3Today’s Goals
CVI assessment and strategies for older students.
C
onsiderations with increased age?
I
mprovements expectations with increased age?
Slide4CVI: All in the Brain
Damage to the visual
cortex
Damage to the visual pathways
Both
Slide5Child
can not process or
understand
visual information
.
C
ortical
visual impairment is the leading cause of visual
impairment in children.
CVI
Slide6Rethinking
Consider assessment and strategies for ocular impairment to be inappropriate for dealing with a child with cortical visual impairment.
Slide7Slide8Slide9Dorsal Stream
Where is the target?
Tells us about the object
’
s orientation in space.
Responsible for eye hand coordination.
Give us perception of movement.
Slide10Ventral Stream
What is the target?
Recognizes:
Faces and facial expressions
Colors
Shapes
Writing
Objects
Slide11Statement 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.
Slide12Agreement
Definition: Brain based visual impairment of visual cortex and/or visual pathways.
All children with CVI should be considered visually impaired.
Slide13Agreement
All children regardless of severity of CVI or severity of multiple disabilities deserve vision services
.
Slide14Criteria 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.
Slide15Low Vision and Legal Blindness
CVI defined:
Visual acuity: traditional acuity measures don’t work for CVI
Visual fields
Visual abilities compared to peers
Slide16Agreement
CVI functioning ranges from severe to mild.
Screen for ocular problems.
Screen for CVI: FVA must be grounded in the characteristics.
Slide17Agreement: Characteristics
Lightgazing
Poor visual attention
Color preference
Restricted fields
Difficulties with visual complexity
Difficulties with distance
Better visual skills with known objects
Slide18Agreement: 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.
Slide19Disagreement
Cortical Visual Impairment
vs.
Cerebral Visual Impairment.
Slide20Roman: Cortical Visual Impairment
CVI and the Evaluation of Functional
Vision
Definition and Causes
Developed an Assessment:
CVI Range
Slide21Slide22Roman: Cortical Visual Impairment
Strategies
and environmental supports
Discusses dorsal and ventral stream: building from dorsal to ventral.
Slide23Ten Characteristics
Color
Movement
Latency
Visual Field
Complexity
Light Gazing
Distance
Visual Reflexive Response
Visual Novelty
Visual Motor
Slide24Ten Characteristics of CVI
Color
:
Does the child attend to certain colors?
Movement
: Does the child attend to moving materials?
Latency
: Does the child need a long time to look?
Visual Field
:
D
oes the child see in one visual field better than in other visual fields?
Slide25Ten Characteristics
5.
Complexity
:
Visual Complexity
Auditory Complexity
Positional Complexity
Slide26Slide27Slide28Ten Characteristics
Light Gazing/Non-purposeful Gaze
:
Does the child always look towards light/seem not to look?
Distance
: At what distance does the child see?
Visual
Reflexive
Response
: Does the child
b
link to touch and visual threat?
Slide29Ten Characteristics
Visual Novelty
: Does the child like familiar things and seem to ignore new things?
Visual Motor
: Does the child reach? Do they reach while looking? Do they play while looking?
Slide30Characteristics on the CVI Range Assessment
Remember each characteristic is on a continuum.
0 1 2 3 4 5 6 7 8 9 10
When a child improves with one characteristic, you expect to see improvement in other characteristics.
Slide31Slide32Slide33Slide34Levels 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
Slide35Goals in each Phase
Phase I: Looking
Phase II: Vision plus function
Phase III: Resolving characteristics
Slide36Phase I
Case Study
Slide37Phase II
Case Study
Slide38Phase III
Case Study
Slide39Fluctuating Vision
What is
“
fluctuating vision
”
?
Consider the environment.
Consider the child.
Slide40Expecting Improvement
Slide41Planning Using Assessment R
esults
Base goals on the CVI Phases.
C
reate learning supports around Characteristics.
Create strategies
and
adaptations matched functional vision.
Environmental changes support child’s needs.
Slide42There is no “Therapy”
You want an
approach
throughout the day.
You want strategies to support and build vision use. (after assessment).
Slide43Dutton: Cerebral Visual Impairment
Definition and Causes
Strategies for current functioning
Discusses dorsal and ventral streams.
Slide44Slide45Slide46Slide47Dutton
No mention of strategies for improvement
.
Created Dutton Survey
Slide48Dutton Survey
52 questions
No mention of
Color, Movement, Latency, Light Gazing, Visual Reflexes
characteristics.
Most concerned with visual field (8) and complexity (33).
Slide49Slide50CVI Across the Ages
Consider Brain Science
Plasticity
Critical periods
Potential for resolution with increasing age?
Slide51Brain 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
Slide52Critical Periods
There
may be critical periods for certain types of learning
.
Slide53The Mystery of the Brain
Assess all students regardless of age.
Place learning supports and
envronmental
in place.
Expect improvement.
Slide54Ten Characteristics
Color
Movement
Latency
Visual Field
Complexity
Light Gazing
Distance
Visual Reflexive Response
Visual Novelty
Visual Motor
Slide55Allie: 19 Years Old
Slide56Resources Brain Development
What’s Going on in There?
The Brain That Changes Itself
Slide57All kinds of kids
Slide58Ocular Impairment with CVI
Any child can have both types of visual impairment.
Be aware of both
Assess for both
Create strategies for both
Slide59What 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.
Slide60To Read More:
Christine Roman-Lantzy,Ph.D.
Jim Jan, M.D.
Gordon Dutton, M.D.
Lea Hyvarinen, M.D.
Mary Morse, Ph.D
Slide61Resources
Cortical Visual Impairment: An Approach to Assessment and Intervention
by Christine Roman-
Lantzy
CVI Perspectives
available on quota from APH
Dutton CVI Survey
Slide62Resources
American Printing House website: CVI
Texas School for the Blind website
Perkins Webcasts: Teaching Resources
cviteacher.wordpress.com
Slide63Resources
The American Foundation for the
Blind: eLearning Center: CVI
Focus
Webinar 5 sessions $179
http
://www.afb.org/store/Pages/ShoppingCart
/ProductDetails.aspx?ProductId=eCVIfocusSERIES&ruling=No
CVI: UMASS Boston Vision Studies Program:
3 graduate credits. Online
Slide64CVI Resources
West Virginia Department of Education: Cortical Visual Impairment
http://
wvde.state.wv.us
/
osp
/vi/cvi/
Slide65CVI Symposium
The End
Ellen
Cadigan
Mazel M.Ed., CTVI
Perkins School for the Blind
May 2015
Slide66Typical 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