I have learned so much from my students. I recall being taught that parents are the biggest experts on their children. The open communication and collaboration is so important in providing for the best for each child. Communication with students is equally important. Each of the quotes you shared resonates with me as well. It is so important to think outside of expected sequences and form individual instruction and frameworks; for me this is actually one thing I enjoy about this profession.
Question #1 1. 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?
I recall working with a preschool-aged student who had been diagnosed with cerebral palsy and suspected visual impairment. Initially, her delays in recognizing letters, shapes, and colors were attributed to overall developmental delays, and many on the teamāincluding myself at the timeāassumed she simply needed more time and repetition to grasp visual concepts. Because she could physically see (based on a standard eye exam) and showed no obvious signs of blindness, her vision was not considered a significant barrier to learning.
This assumption shaped both our instructional approach and our expectations. Materials were presented in cluttered visual fields with multiple stimuli, and visual tasks were emphasized in the same way they would be for students with typical visual processing. When the student didnāt respond or seemed disinterested, it was often misinterpreted as inattentiveness or lack of motivation. Our expectations were unintentionally lowered, and we missed opportunities to engage her in ways that were visually accessible to her.
After a team meeting and discussion with her parents and eye doctor we revisited the students behaviors determining that her difficulty wasnāt from a lack of cognitive ability, but from being overwhelmed by visual complexity.
We made several changes: simplifying visual backgrounds, using high-contrast and familiar objects, and presenting information more slowly and predictably. With these adjustments, the student became noticeably more responsive. She smiled more, reached for objects, and began to show emerging recognition skills that had previously gone unnoticed. The experience taught me how deeply embedded assumptions about development and vision can impact the support a child receivesāand how important it is to continually question those assumptions in light of new information.
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Thank you for sharing your experienceāit really highlights the complexity of supporting a student with both CVI and TBI, especially in an early childhood setting. I appreciate how you and your team approached the situation with collaboration and a willingness to learn, even when the information was limited. I think itās incredibly important that you acknowledged the assumptions that were made based on what is typical for preschoolers. Thatās such a common starting point, but as you observed, it doesnāt always fit when CVI (and TBI) are part of the picture.
I also found it really encouraging that the teacher took the initiative to research CVI and that the team kept the environment visually accessible. Your strategy of observing how the student navigated different settingsālike stairs and playground equipmentāwas so valuable, especially given the limited vision data you had at the time. It was also a smart move to seek out a second FVA and attend a low vision clinic. Those steps show how committed you were to deepening your understanding and refining your approach.
Your reflection about doing things differently now resonates with me. CVI really is a learning curve, and your openness to learning more and supporting your team going forward is inspiring. It reminds me how critical it is to stay flexible, seek out experienced voices, and continue building our own toolkits for future students. Thank you for sharing your journeyāitās one many of us can relate to and learn from.
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Thanks for sharing your thoughts! I agree that parents really are the experts on their children. They know their child best, while professionals bring helpful tools like observation and data collection. When both sides work together and communicate well, it leads to stronger support for the student.
I also related to what you said about sensory complexity. Students with CVI can easily get overwhelmed, and I liked how you used one sense at a time to help your student focus. Using auditory cues, careful seating choices, and a personal schedule are great strategies. Itās clear you were really thoughtful in creating a calm and supportive learning space. Thanks again for your postāit gave me some helpful ideas!
I always find it so interesting how different levels of complexity can impact each child with CVI. I love how you were able to see such a noticeable difference in the childās ability to access materials with just a few minor changes to the object and environment! Iām assuming that you provided these modifications within a resource room setting to help with environmental controls. I am not sure how long you worked with the student, but did you ever find that the child was able to tolerate more complexity as they became more familiar with the task or objects they were looking at? Also, the use of predictable routines is so helpful! When children know what to expect, it becomes easier and faster to understand the task.
I am responding to Question 4
I went through my training quite a few years ago, and although the training was in-depth and covered many aspects of vison, I received very little training in the area of complex visual needs. Working and serving in a very rural area has limited my hands-on experience with various visual abilities. Consequently, I have relied on further training in multiple areas of vision. Since Zoom offerings have been more readily available, I have managed to increase my knowledge over time.
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I enjoyed reading your wonderful success story. As an Early Intervention teacher for many years before becoming a TBVI, and being a part of many different classrooms, I too came to understand how important the present environment can impact the learning of all students, I liked your thoughts on environmental conditions as a first possibility to make positive learning changes in your student with CVI. Sometimes we get caught up in all of the expected activities for certain conditions and overlook the obvious. I do not have a lot of experience working with CVI, so I am grateful to be able to learn from awesome collaborators like yourself. Thank you
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Your comment on daily routines spiked my interest. Establishing daily routines and repetition always made sense to me, and it was always a great way for parents and caregivers to feel acknowledged and included. Parents and caregivers truly are a childās first teacher. I have taken my routine-based intervention training and have used it with all ages
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 teamās understanding of CVI and its impact on a student?
-CVI is not primarily a disorder of language, learning, or social communication.
-Visual function refers to how the eye functions (measured by clinical tests such as visual acuity)
-Functional vision refers to how the person functions while performing activities that require vision.
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Observations in a standard clinical setting may not accurately reflect difficulties with functional vision at home, school, or other situations
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Behavioral characteristics of CVI include light gazing, eccentric gaze preference, preference for brightly colored and moving objects, difficulties with detecting objects that are closely spaced or on complex backgrounds, and fluctuating levels of vision, with worse visual behavior associated with fatigue, illness, or unfamiliar environments.
(1) CVI encompasses a spectrum of visual impairments caused by an underlying brain abnormality that affects the development of visual processing pathways and is characterized by deficits in visual function and functional vision.
(2) In CVI, visual dysfunction exceeds what comorbid (simultaneous presence of two or more diseases or medical conditions in a patient) eye conditions alone would predict.
(3) The visual dysfunction in CVI may manifest as lower-order or higher-order afferent visual deficits, or both, leading to characteristic behaviors in affected individuals.
(4) Although CVI may be comorbid with other neurodevelopmental disorders, CVI is not primarily a disorder of language, learning, or social communication.
(5) The underlying neurologic insult of the developing brain may go unrecognized or undiagnosed until later in life.
Cerebral/Cortical Visual Impairment (CVI) refers to visual disorders caused by brain abnormalities that disrupt visual processing pathways, resulting in deficits that extend beyond those explained by eye conditions alone. CVI can involve both lower-order issues, such as reduced acuity or visual field loss, and higher-order problems, including impaired motion perception or face recognition. Typical behaviors include light gazing, object preferences, and difficulty in visually complex settings. CVI often coexists with neurodevelopmental disorders like cerebral palsy and autism, but remains distinct in its origins and symptoms. Diagnosis is challenging and requires differentiation from conditions like amblyopia or delayed visual maturation. Early detection is essential for effective intervention.
What has helped me communicate across teams to use the term "CVI Characteristic which are closely related to Autism. The team is generally familiar with the characteristics of autism spectrum disorder. It becomes very tricky when the student has not been diagnosed with autism. Frankly, when a student is MDVI, they usually focus on the higher disabilities. I help the team to understand the characteristics defined by Christine Roman-Lantzy, PhD. The ten characteristics are easy to understand and are more focused on the functional vision use. Although, since studying the Perkins Protocol for CVI, the term visual behavior is beneficial when explaining the studentās functional vision. I created a comparison chart to compare each term. See the attachment.
In conclusion, historically, ācortical visual impairmentā was used, but ācerebral visual impairmentā has become more common to account for the involvement of subcortical and association brain areas. This working definition aims to unify terminology and improve both research and clinical care for those affected by CVI. The term used to describe CVI to the team will impact the student in the compensatory area. If the term manifestation is used, it is comprehensive and does not involve how the student functions visually. Yet, the use of visual behavior and visual characteristics will allow a more precise understanding of how the student functions and the behaviors of CVI.
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Hi there Adullea,
Working with parent is very essential for a TVI. I have learned to listent to parent for the main reason you stated. theparents are the student first teacher and the parent spend more time with the student. I recall my first year as a TVI, when a parent said to me that her child has light perception. I did not see any evidence of this nor did the eye report state light perception or some light perception. After working with the homebound teacher and as we implemented the CVI strategies, I was able to affirm yes, he does have light perception. On the annual eye report the doctor notated that the student had some light perception. Game changer when it comes to listening to the parent for the very reason. the parent will know how their child function at home using his/her functional vison. Communication and equal respect will positively impact the students growth and outcome. Thank you for your post.
Hi there, MHopkins! Thank you for your post. Itās funny; I had a student similar to yours. To add to the story, my student appeared to have functional vision but also faced cognitive challenges and had cerebral palsy. The teacher had many assumptions that I ended up following. The studentās eye report did not mention CVI (Cortical Visual Impairment), which made it difficult for the teacher to provide proper instructional feedback. Although the student could navigate her environment with her vision, the teacher did not understand that the characteristics of cerebral palsy and CVI can be closely related or even the same. Iāve created a comparison chart of the three terms. You can check it out at Week 2: July 6-12 - #92 by gloriousbrich.
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Most of my more complex students have large teams that include SLP, OT, PT, etc. and each of them has their own āagendaā for what is most important for the student. This can become challenging when they are trying to instruct using strategies and expectations that they apply to typically sighted children. As well intentioned and caring as they all are, they are not necessarily incorporating strategies in their sessions to support accessing vision. For example, a preschooler whose SLP was trying to gain attention was using a rubber bouncy ball - this student could not possibly track the path of the ball. (I suggested a balloon or other more slowly moving object - bubbles, fabric, so many options!). So of course the student appeared disinterested and likely was just frustrated. They were also asking him to participate in an environment full of novel and complicated things - toys, walls covered with letters, numbers, and artwork, visually complex carpeting, multicolored tables - goes on and on.
I work with another CVI student whose case manager (out of an abundance of good intentions!!) put down a rainbow of colored rubber mats in his space. I felt badly explaining that a black (or at least darker solid color) flooring would be easier for this student. They did adjust, which I appreciated.
Without exception the teams I work with care and are trying their best for the students, but CVI requires strategies that are not what is typically done for students without CVI. I would āargueā that reducing complexity and sensory input would benefit just about all students who are being ask to learn and attend. But that is a bigger mountain to climb!
Hi Amy. Iāve had the same experience. I was working with a complex student (CP and CVI) who had shown no interest in books. Then one day while there with him I asked his staff person to let me move him to his table, seated in his activity chair (which supports his torso and posture). In that situation he was very interested in the books and I explained that it was because he no longer had to manage his whole body but could ājustā look at the pages. They had been exposing him to lots of activities and books, but always while he was lying on the floor or in another unsupported posture. We are all learning - each of these students has different needs but this one (secure seating) has proven to me to be invaluable. So, thanks for sharing your experiences too!
Hi Kim.
I have been having this conversation with a team for a student who has no structure or consistency in his day. He is (unfortunately) by himself in a room with 2 staff people and essentially he rules the roost - if he gets escalated or angry about a situation he just gets his iPad and chill time. Iāve been encouraging the team to consider a simple and fixed calendar system for him so he will begin to understand what is going on more and perhaps feel some control over his day if it is predictable. Yes, he controls it now but not in a positive way. I believe his current sensory environment, coupled with the lack of structure is making it hard to be successful. Iāve also encouraged the team to understand that it will take a bit of time and patience as he adjusts to this, so if by the end of September they arenāt seeing a 180 degree change to not be discouraged. I believe it will be worth it - would love to know from others of experiences like this.
Question #1 1. 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?
In the role of an itinerant teacher, we have become accustomed to using our car as an office, lunch area, decompressing area, and, of course, our mode of transportation to support all of our kiddos. Along with my caseload, I have a handful of students who are homebound. Due to medical reasons, the doctors have recommended that these students not attend school. Some families have medical personnel in the house due to certain conditions. The school district provides once-a-month services by the related services providers (OT, PT, SLP). I come into the picture when the student transitions to the school system at the age of 3. CVI is a diagnosis written in all of their paperwork.
I feel this is an area I want to improve in to shift my perspective and understand more what the studentsā vision with CVI. Prior reports developed assumptions of his/her vision to the team. This is also a touchy situation when you donāt have the school setting with all the appropriate environment and equipment. As a provider, you are going to studentsā houses, which in my case are usually in a rural area, and they reside in housing that reflects economic hardship. Not only are assumptions made about their vision, but other surrounding observations. I have observed that those assumptions affect the approach or expectations. Believe me, I have had my share of dog bites, domestic incidents, and no follow-through of recommendations. But expressing the small celebrations of success you didnāt observe last month can resonate with the family. Not only does the parent or caregiver have the best information about the kiddo, but so does the home health staff. Now I usually ask when I get to the house, āHow were the kiddos night or morning?ā It could be they sat in the doctorās office all morning, needed medication for seizures, or is very happy and content.
After listening to my colleagues in New Mexico on Identifying the Effects CVI and the other resources mentioned, I need to look at all 16 manifestations to get a better picture of each studentās universe (Dr. Amanda Luekās). Obviously, this cannot be done in one session, but I present a variety of interventions to the team in order to optimize the learning environment they are currently in. Another change I made was co-teaching with the homebound teacher who supports these kiddos more than once a month. More data and pertinent information obtained. Plus, the homebound teacher has made in many cases a good rapport with the family/staff.
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Thank you for mentioning the position these students are in is crucial. My mentor in the TVI program mentioned that studies have shown the upright position can benefit not only vision but the whole body. The students I support who are multiply impaired show more engagement in the items presented in an upright position. But I have also observed that when the student is concentrating in equipment (usually the stander) that PT has recommended, sometimes the vision is effected. I usually find the comfortable supported upright equipment the student is familiar with.
I agree the classroom is usually well-meaning staff. My mode in the schools about background clutter and CVI is always on my mind. For some reason, I couldnāt transfer that knowledge to my students who are homebound. I started to realize that my attire showed bright colors. And how do I expect my student to engage in the brightly colored toy? Being in a hurry often, I finally started to take an old black sheet that I put over my clothes. Also during an IEP, I described a low-complex environment for a parents daughter with CVI. The parent responded that she uses a black background to post make-up products online. I now use it during my sessions.
- Compare and contrast the roles of parents and professionals in interpreting a childās behavior. How can these perspectives complement one another?
When interpreting a childās behavior the role of parents and professionals helps to build a more comprehensive understanding of the child. The parents see the child in a familiar environment with people they know intimately. There may also be siblings at different ages and developmental milestones that they are interacting with. The family may or may not provide the student with more support at home. Understanding what works and doesnāt is informative. In the school environment the student is interacting with a variety of professionals from related services to classroom teachers, para professionals, and specials teachers as well as peers. Each experience brings bring a different perspective of the student. By gathering information through observation in different environments or through interviews (formal or informal) with other professionals we are able to better provide accommodations to support a student. Sometimes even knowing what isnāt working, we have clues to what might work. We can not be in all places at all times and need to rely on a collaborative approach to knowing our students for assessment and instruction.
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In reading the responses to this question Iām feeling like I got lucky with my professional prep program. I felt equipped with the information to provide support to my students with CVI. Additionally, the team of teachers I work(ed) with were also of the collaborative mindset. All of my students with a CVI diagnosis also have complex bodies and are often with the same teachers/teams Iāve worked with over many years. The team members rely on me to provide an understanding of CVI and how to best accommodate the students needs because their professional prep program glance over visual impairments at best with nothing in depth on CVI specifically. Once the team learned the student better, the sharing of information and accommodating the student became more fluid between team members.