Instructions: After viewing the modules for the course Identifying the Effects of CVI, participants are expected to respond to one of the questions posted in a manner that reflects an appropriate level of analysis and engagement in the discussion; applying the knowledge and insights from the readings to practical applications; drawing conclusions based on the content, raising new questions, presenting a counter argument, etc. Each response should include the question number, be stated in complete sentences, and apply the knowledge from the readings and sessions to practical applications.
In addition, each participant is expected to comment on at least two participantsâ responses. The responses should be reflective and thoughtful, not simple short answers like âI agreeâ or âMe too.â A thoughtful response integrates readings, may provide examples, add new information, or present a counter argument.
Reflect on a time when assumptions about development or vision influenced how a student with CVI was understood or supported. What assumptions did you or others bring to the situation? How did those assumptions affect the approach or expectations? What helped shift your perspective?
Compare and contrast the roles of parents and professionals in interpreting a childâs behavior. How can these perspectives complement one another?
Think of a student with CVI youâve supported. How did sensory complexity, attention, or the environment impact their ability to access instruction? What helped or hindered their visual attention? What strategies made a difference?
To what extent do existing professional preparation programs (across fields) equip practitioners to understand and serve students with CVI?
Consider how has the use of different terms to describe CVI (e.g., CVI, cerebral visual impairment, neurological visual impairment) may affect collaboration with other professionals. Has inconsistent language ever caused confusion or misalignment? What helped clarify communication across teams or settings? How do you navigate terminology in your own practice?
What are the key similarities and differences among the three sets of terminology (Visual Behaviors, Characteristics, and Manifestations) used to describe CVI, and how might these differences impact a teamâs understanding of CVI and its impact on a student?
Many times, other professionals and classroom staff working with a student with CVI do not understand all the variances and nuances of this condition. They often have visually busy/cluttered classrooms that seem great, but for our kids with CVI - do not allow for an optimal learning environment. Students may present as if they are not seeing items and classroom staff may assume the student has no functional vision. Classroom staff may not present materials appropriately to these students, resulting in missed opportunities for student learning. I usually go into classrooms and work with staff to determine what is a motivating object for a student and determine what makes the item motivating. Color, visual simplicity, shape, texture, sound etc. may all be factors. Understanding the use of the familiar and motivating to introduce new items is important to help our students expand their array of toys and objects they may interact with or respond to visually. Many times, when I have gone into classrooms bringing just a work play tray in black and yellow and guiding classroom staff on proper presentation of motivating, familiar objects to students, they see a student respond differently and this can help make changes for a more ideal learning environment for the student. We then can build on this to help a student respond more consistently and to possibly a greater number of objects in their educational environment.
Dr. Lueckâs blog hit home, and I thought that I would write about my experiences with this question. However, youâve done such a nice job of summing up the cluttered classroom and staff scratching their heads about why little Aubrey isnât responding. I would add that over the past 5 to 7 years, as more information about CVI has filtered into classrooms, I have found that classroom teachers grabbed hold of the tangible parts of old CVI information that made sense to them, whether it was beneficial for the student or not. A primary example that seemed to be in many separate classrooms was using only red and yellow objects with students who had a CVI diagnosis. It is rewarding to help staff understand how to observe student responses to activities that can then be changed to better fit the studentâs needs. Also, staff can be empowered to make needed modifications and accommodations for the student that align with the classroom routine. When staff are an active part of the change in how the curriculum is presented to the student, and they see the difference in the studentâs responses, then everyone wins.
Compare and contrast the roles of parents and professionals in interpreting a childâs behavior. How can these perspectives complement one another?
The roles of parents and professionals in interpreting a childâs behavior is complementary by nature. The time we spend with our student is limited, but it is not without opportunities to observe our student communicating and reacting in the school. We can be limited or blinded in the routine of the school day. Assemblies, field trips, classroom parties/dances give us additional opportunities for new perspective. Bonus points if you are also a COMS and can take your student to new places. Parents have a lifetime of observations and deeper, more intimate knowledge of a childâs behavior in various contextsâat home, during family events, etc. The right questions can bring valuable information. Sharing observations in the school setting with parents can confirm if the observations carry over to family life and it helps identify patterns. This creates opportunities for families to share their observations on other topics. This solidifies what I think of as a caring bond between TVIs and families. Additionally, sharing observations with professionals working with our students has similar results. Collaboration is the key to getting parents/professionalsâ observations and then recognizing the manifestations that presented in that moment. Sharing insights helps ensure everyone is on the same page, making it easier to identify behavior patterns, triggers, and appropriate interventions. The more we know, the better we can help with strategies and solutions for the childâs success. I liked the ending of the article stating by understanding the how our student operates in the world and how he or she experiences it helps us encourage and empower that student to be themselves and to acknowledge their behavior as a strength.
This question took me back to so many of my students with CVI struggling to adjust in environments that caused them to shut down. Many years ago (too many), I had one young student with severe spastic quadriplegia and CVI. He had been placed in a separate PreK classroom for moderate to severe developmentally delayed students. I encountered classroom staff who thought the goals for the student were not attainable. Because of the type of classroom he was in, some students did not come every day; however, he attended the classroom the entire week. Observations demonstrated that he completely shut down and often went to sleep when certain, louder classmates were in the classroom. When these students were gone, he was like a different student. He smiled, looked at staff, and tried to get their attention with vocalizations. He showed interest in activities that used bright primary colors and/or shiny Mylar, but they needed to be presented against high contrast (solid black or dark blue mats, trays, and black tri-fold boards worked best). We found that if we added a little Mylar to an object to get his initial attention, he gradually learned to recognize the object when they were presented one and then two at a time on the solid colored trays. Visual fatigue was a major issue, and the classroom teacher and I worked together to create a CVI space in the classroom. This allowed him a âquieterâ area and blocked extraneous visual information. He could rebuild not only his visual battery, but we found that it also helped his tone. The speech therapist and I worked together to promote his eye gaze, and this was way before eye gaze devices. We found that by using a black velcro mat, we could present a choice of two pictures (we started with objects, but he quickly mastered this). When called upon in circle time, he had his own black mat on a slant board, and he could shift his gaze to look at the correct weather choice or day of the week. This led to asking him simple questions about the book that was read during circle time. We first tried using pictures from the book, but then found that he did better with pictures of real objects that related to the book. By now, I was working with all of the therapists, and we also created a small CVI space outside of the classroom for days that were a little too chaotic for him to handle, even with his space in the classroom. Both spaces were also used to deliver therapies within the classroom and outside of the classroom, when he was rested. During all of this, the teacher had me give two workshops about what was known about CVI at the time. I cautioned them not to make decisions about a childâs preferences, as well as to make accommodations and modifications around complexity and contrast, distance, use of light, and present a little more to his right visual fields, rather than creating CVI activities. I also emphasized that if the student was not responding as expected to look first at what was going on in the classroom, i.e., was it loud with kids moving around quickly? How long had he been working, and did he need a break? Had he had a change with his seizure medications? Had he slept the night before? Was he feeling unwell? All of this could affect his vision. The teacher and speech therapist began to look into building him a simple communication board that could be added to, as he began to tolerate more complexity. The best ah-ha moment came after the speech therapist and I found he was picking up on letters when presented with high contrast, and at this point, 2-3 at a time. Using eye gaze, he began to put letters together into short words (this was before bubbling). We used rounded, bold, yellow cut-out letters against the black mat. We also used an âalternative pencilâ format, which was augmented to use the words he had learned to tell short stories. By the end of his two years in this classroom, the IEP team saw that his setting needed to change for kindergarten. He still needed a great deal of support for communication, physical, and vision challenges, but he had begun to communicate with staff via the communication board. He was the only child in the classroom who could read and do simple addition problems. He placed out of the separate classroom setting into a smaller kindergarten classroom that had started the year prior, and he was to receive enrichment and resource room services. Youâre probably asking why we didnât use switches. We did, but he could not control his arms and hands enough to activate them, and he received Botox. We tried him with switches that went on either side of his head and at his knees, but he actually did best with eye gaze on his communication board. It took time and patience, but staff realized that this child had been trapped in his body. He was finally able to let others know what he wanted and needed, and he could âtalkâ and ask questions like most preschoolers do. The classroom was willing to support him, and the outcome was incredible. It takes a village for our kids with CVI, and everyone needs to buy in. You never know what a studentâs potential may be.
Megan, you are so correct about nurturing the bond between parents and TVIs/COMs. Because I worked birth to five VI for many years, I had the chance to really get to know the parents of my students, as well as grandparents, siblings, and other family members. No matter the familial make-up, the key was to listen and understand the parents/caregiversâ knowledge and experiences. If we wanted to keep our âfoot in the doorâ, this understanding was crucial. Making sure parents saw what I was seeing by having them watch me and then participate in the activity helped to build trust and a good working relationship. This also allowed parents to take more power in their childâs progress. Fitting activities into daily routines helped to encourage parents to implement what they had learned between visits. Discussions about what went well between visits, or what didnât go well, and why were also very important. Parents understood that this was a process, and their input was just as important as the TVIs. I think this also helped parents to discuss behaviors or other problems they might be having with their child, and whether vision issues were contributing. Doing co-visits with the childâs therapists also allowed parents and the therapists to see how vision affected responses in other developmental areas and how using certain accommodations could help the child meet goals. All of this can be transferred to school systems, as you have illustrated beautifully. Iâve always sent notes home after each visit and conferenced with K-12 parents. I also found that keeping within the classroom routine as much as possible built better relationships with teachers and staff. Pushing into classrooms with students when possible, rather than pulling out, allowed teachers to see the TVI in action and how the placement of the childâs seat might need to change, or why the child needed to use both their video magnifier and iPad. I think my favorite quote from Dr. Lueckâs blog was âEach child is a universe.â The childâs universe includes the people who care for them, and it is essential to involve them.
As a professional in the field of CVI you learn the âlingoâ in each setting you work and the âlingoâ that each professional you encounter may use. You may feel comfortable with one term or another, but you eventually realize that you will need to learn all the terms when working with other disciplines.
The use of multiple terms to describe the same thing seems to affect a variety of areas in the field, and sometimes even impedes collaboration with other professionals. I was involved in an IEP meeting not long ago where some professionals and the parent used a different term to label the same thing (the childâs visual impairment). This certainly interrupted the meeting and the professionalsâ efforts to create the IEP plan for the child.
If you find yourself in a meeting with a professional or parent that uses a different term then I like to try and guide the discussion toward using the same terms or to clarify what a member of the team may mean when using a certain term. I also like to make sure that when I do documentation, in parenthesis or later in the report I include a sentence about terminology (ex. CVI, also known as cerebral/cortical visual impairment). I also like to do the same with terms I use that may not be as clear for someone outside the field in my FVE documentation.
If possible, I try to (at least) have a scheduled training at the beginning of the year on common visual impairment diagnoses for all team members, including terms most common in the setting and ones that may or may not be the same. When working with students, I also like to start any report by focusing on a childâs functional visual behavior (rather than a diagnosis).
As you can see, although the field of CVI continues to use several different terms for our area of interest, these are some of the things that I have found work for me and in many ways do not take a lot of extra effort. The main thing is to remember that when the focus is to provide the best outcomes for those we serve can for what can be an incredibly complex diagnosis that requires a multi-pronged approach.
I agree with everything you said. I think a very key component is follow through. I think things in our business can become very technical and involved and trying to keep things as straightforward and simple for staff to maintain consistency with students who have CVI is crucial. As much as I would like to build sensory corners and do all the other great things we know help our students, giving staff tools they can use throughout the educational day has worked for me the best - contrasting surfaces that are portable, identifying items a student prefers and then working with staff on building same but different integration of new items, helping staff identify appropriate wait times and movement cues that will help a student better respond visually etc. It is always finding that system that can be implemented that is effective but not overly complicated for all staff to use.
Your comment was helpful since we can easily get in a "rutâ so its good to think of what I personally have been doing. One thing that I know is that if I take the time to think about and use proper presentation of the motivating objects then it can make a huge difference in how the student responds to that object. For me, it is taking/and or making the time to see what will work for the student.When we take the time to present learning opportunities in the way that the student can access then they are able to respond it can help the very busy classroom staff to work with the student. Its important to work up from the successand to help other staff to see the studentâs response change and realize that presentation and measuring the response mode was what was needed to help the student access materials.
I appreciate that you are taking the time to work with the classroom staff, that can often be overlooked.
I like the training you mentioned - it is so important for all staff working with our kiddos to understand the implications of what CVI involves including the language that accompanies it. I also think you make a great point - making sure that people who are not in our field understand what all these terms actually mean. The longer I have been in this field, the more I have learned to keep things simple - people often only really read the summaries of an FVA. If you use language someone does not understand regarding a student, the information isnât really helpful. We all get it but making sure families and other team members understand reports and progress information is essential.
The more parents and teachers communicate, the better partnership that they will form, and this is of great importance for a childâs development. Parents should feel that teachers really care about their child and want to know more about them. Carefully selected questions to parents about how their children act at home, what their interests and needs are, what they find easy and what they find difficult, will help teachers to identify the motivations behind behavior and improve support for their students. Teachers also can share important information about their childrenâs behavior and development at school with their parents and this also will add to the big picture.
I appreciate how you pointed out that when both parents and teachers discuss their observations about the childâs behavior, they may notice some patterns or changes which will give them more information about the child. I have found that it is very important not to jump to conclusions but try to look at the bigger picture.
It can be challenging to have that meanigful communication. I appreciate the emphasis on forming a home-school connection and set up a system to share and exchange important information about children to provide them with a better support. Then the respect will be mutual. That was a good point to bring up since we can sometimes get lost trying to solve challenges that we could more easily solve with good communication.
Think of a student with CVI youâve supported. How did sensory complexity, attention, or the environment impact their ability to access instruction? What helped or hindered their visual attention? What strategies made a differerence?
As a new TVI, a student at one of our districts got Lyme Disease that summer. He now was completely blind. He was homebound and dad just wanted us to know so we could come to his school and provide support when he was well enough to return. He returned in January of that year. He had restricted vision enough to be legally blind but was labeled by the doctor with CVI. His vision slowly but surely improved that year. Four years later, his vision has stablized. He is still legally blind. He has tunnel vision and is so excited his vision has returned enough that he can see a complete worksheet, the board, and chessboard. I started to take the CVI Certificate program at UMass-Boston right after I was newly certified. The coursework gave me a lot of information about CVI. One of the things I found most useful was their emphasis on looking at where the child visually is. Help them learn accomodations for how they currently see instead of helping them see better. Eventually, this student was struggling to read. He read at grade level before Lyme Disease and was now struggling to complete group assignments. With my background as a teacher of the deaf, and learning that with CVI many also struggle to auditorily process information, I wondered if he was struggling in group because of an inability to process information with all the auditory clutter of the small group setting. His district is very responsive and had him testing to rule that out. He did have auditory processing and now has an FM system that helps him hear what is being said in HIS group, instead of all the groups and when the teacher has the microphone, he can hear what she says above the small conversations students are having around him. It has made a big difference. I do think it is important as a TVI that we step back and look at the big picture, esp. with our students with CVI. If they have a brain-based visual impairment, we need to always ask, what other struggles may the brain have processing besides vision?
I should add, with the FM system on, he was able to read at grade level. It was trying to read while hearing all of the other classroom distractions that was causing the reading comprehension issue, not his vision.
I love what you have done here. I have found, too, that one example that leads to success is so much more powerful! When I first started as a TVI, I think I overwhelmed classroom teachers with too much. Providing the one tool that would make the biggest difference is such a great way to begin!
Unfortunately there have been many instances where assumptions about development or vision have played a role in determining whether or not a student even âqualifiesâ for services related to visual impairment. Specifically in instances where the student has additional complex medical, behavioral or intellectual disabilities. It has been my experience that either fellow professionals are reluctant to learn about CVI, and a ânew way of thinkingâ or they believe they are triaging students and the academic students come first.
I have seen this first hand as an Orientation and Mobility Specialist. I serve students in a secondary school district (7th grade-22 yrs) and often the elementary school district which âfeedsâ into my district dismisses students such students before they transition to the 7th grade. I do my best to pick them back them up. The elementary school staff I believe assume that the student will not make progress, so they have low expectations. I have high expectations, and I love to see my students progress with proper supports embedded within routines.
Additionally, I have run into assumptions from parents, students and other professionals who mistakenly assume that if an individual has perfect acuity then they do not have a visual impairment. I fought for service for a 20 year old student who with correction has perfect acuity, but did not recognize me in an unfamiliar environment from 2 feet away until I spoke. The studentâs parents reported that the student clings to them in noisy, crowded environments and probably could not isolate them in a crowd. The student tripped multiple times as they missed items in the lower quadrant. It was then through an extensive educational program with parents and staff, that they agreed that the student in question had a CVI and required services.
The more I learn about CVI the more my perspective shifts, as to the necessity of services for students with CVI. My focus now is on educating others, so that my students receive necessary services and supports.
I could not be an effective COMS if I did not nurture and develop a strong rapport between my parents, fellow colleagues and students. You are so correct in the value of mutual respect, listening to one another and to be willing to learn from one another. Parents are the experts on their children, and they are my starting point with assessment, and my continual touch stone. I ask families about their daily routines, what are their short and long term goals and how can we work together to support these. I invite parents to come observe lessons, I offer to provide lessons in the home environment too. I want to show parents how to implement strategies or techniques into their everyday life. This also applies to my fellow colleagues. I too push into classrooms, and embed myself into the students routines. This helps fellow staff observe how to implement strategies and techniques, and to feel free to ask questions. Pushing into classrooms also helps me to be a part of the classroom culture and not a distraction.
As a COMS your comment about teaching about appropriate wait times and movement cues hit home. I know part of my job is teaching to travel âefficientlyâ but that does not always mean quickly. There have been times where it was the staff who needed to trained about wait times, and the effects of visual latency. That it may take a student time to visually locate and identify a landmark and then process what to do next. Additionally it could also be that traveling during passing period with all the commotion is too much so the student waits until the noise level and movement is at a low level. I am fortunate in that the majority of personnel I work with once they understand what is happening they are on board with implementing strategies.
What a wonderful story that highlights the benefits of collaboration and understanding the CVI profiles. Observations showed that he had needs and when he was supported, he blossomed. This in turn motivated the staff and collaboration resulted in growth, literacy, and literally coming out of his shell. Itâs great that you advocated for a quieter space and a CVI space outside of the classroom. I advocate for my children, especially with the speech symbols on the talkers. We are using color photographs in some instances. You were giving the right adviceâŚkeeping him in classroom activities without the need for having special CVI activities. You are helping others to think about the environment and not taking behaviors at face value. Thank you for sharing!
When people are reluctant, find ways of sharing resources or making connections to âseeâ the CVI profiles within the school environment. I have sent many OT/SLP related videos/webinars to my colleagues.
I work with my students with multiple disabilities learning O&M around the school campus. I take an older student to the local grocery store once a month to find things on the shelves. The district was willing to transport her when she arrives at school. I tried this approach with another district and was denied, sadly. I do have opportunities to go out on Community Based Instruction with certain classrooms if it works with my schedule.
I ran into the same issue you mentioned with a parent. Our student shows characteristics of CVI. He has a medical history that could indicate CVI, but he does not have an official diagnosis. At the last IEP, the eye doctor indicated better vision and his Mom clung to that. She didnât want him to look at CVI-friendly books anymore. At the end of this school year, his parents wanted a log to be implemented after every lesson. This will give me a chance to share my findings more consistently and build the relationships to foster sharing of insights.
Think of a student with CVI youâve supported. How did sensory complexity, attention, or the environment impact their ability to access instruction? What helped or hindered their visual attention? What strategies made a difference?
One of the students I have worked with recently began kindergarten in the regular education classroom with 20 of her peers. I discovered fairly quickly that this setting was way too complex from a sensory standpoint for Ella. Strategies such as using an Invis-Board and changing her seat were employed with little difference. While the classroom teacher appeared willing to reduce some of the clutter associated with the classroom, these changes were not effective for Ella. She was offered the opportunity to do some instruction in a resource classroom that was much better suited to her from a sensory standpoint however she was limited in when this room was available to use.
At the end of kindergarten, changes were made to the educational team and plan for Ella. She was going to receive the bulk of her instruction in a resource classroom. This classroom was significantly less cluttered from multiple perspectives, lower lighting, less educational materials on display, and less students which equated to less distraction of movement. The special education teacher who was now on the team was willing to make the changes I was suggesting. This collaboration was incredibly impactful for Ella. Her seating was chosen specifically to limit the distraction of movement although some of this happened organically. There is a lot less movement with 8 students than 20. We were also able to manipulate instructional (ELA and Math) times to periods within the day that were optimal for Ella rather than prescribed times that others received instruction. In addition, muti-sensory activities were also added. Materials were adapted specifically to meet Ellaâs educational need.
Overall, the strategies that made the most profound difference was the fact that true collaboration occurred within the educational team.