I once worked with a student with CVI, and through collaboration with our assistive technology specailist, we developed a strategy using cotton balls infused with different essential oils. This multisensory approach helped the student respond and cross midline, which eventually enabled her to use her head to activate communication switches placed near her cheeks to answer simple yes/no questions. We found that combining visual and sensory input was essential for capturing her attention. The environment also played a significant roleâshe struggled to respond in noisy settings but showed remarkable engagement when working in a quiet, familiar space with her parent, me, the speech therapist, and the physical therapist. This experience highlighted the importance of both a multisensory approach and a supportive, predictable environment for her success.
As this field and topic has changed dramatically over my 30-year career, I think itâs important that we try to keep up with some of the changes. Red, black and yellow have been the colors said to attract the attention of a student with CVI. When doing an evaluation, I will ask what is her/his favorite color? (instead of do you notice if they respond to red, black or yellow) Sometimes it is the standard CVI colors, but more often than not itâs something unique to the child. They are truly unique and special.
I love this idea. It is amazing what motivates a student to respond and open the world to communication and learning. The smells will engage her senses and communicate that its time to learn. She can enjoy the lesson due to the positive engagement of the smell paired with the task or activity.
At the beginning of last year, we received a new student 10th grade diagnosed with CVI. Her teachers and other staff working with her found her challenging due to her constant movements and loud outbursts. After speaking with her TVI I planned a visit to observe the student. The TVI has a space in her room with twinkle lights, and no clutter on the walls. The room was also quiet. While working the student, the teachers noticed she was not making loud noises, or big grabbing movements. (hair pulling, lanyard pulling). She was activating a switch to play music and visually searching for bright colored objects on a page. Conclusion: The environment in the classroom, loud bright and cluttered, was causing much distress. The student has so much potential that was not able to be displayed due to over stimulation. The teacher implemented a quiet black background space with low light for times when she was stressed or needed to complete tasks.
Of course! Hereâs a polished version of your response:
Yes, I completely agree. I never would have thought to use cotton balls and essential oils â what a creative idea! I truly believe that when we collaborate effectively with other professionals, it creates more opportunities for our students to thrive in every aspect of their education.
- 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?
I have a student whose school hallways have large floor-to-ceiling glass panes in sections. Depending on the weather and time of day, glare from the sun can make travel challenging. We have been trialing a few different strategies to help with traveling in this area, such as switching which side of the hallway they travel on (sometimes staying to the right side is too difficult), using brightly colored cones to add contrast when shadows are present, and using contrasting textured tape in areas to encourage trailing the wall at times where switching to the opposite side is not feasible.
Totally agree with you Amy, the role of the paraeducators/paraprofessionals is an essential role that does often get overlooked. I recently had to write a justification letter with the rest of the education/related service team on why a student benefited from having one, and the list of all the areas regarding safety and access that they help facilitate in the studentâs day was LONG. And just as you mentioned, they often know the student very well and when given education and resources, they often carry over the strategies frequently throughout the school day.
Using Zoom and other teleconference platforms has been a tremendous help with keeping up on the ever growing research related to CVI. Since the pandemic, there have been a lot more opportunities to continue to learn and stay informed aside from in-person conferences. Itâs definitely one of the positive things to come out of the pandemic.
They donât⌠or at least mine didnât! My intermediate district is seeing a huge increase in students diagnosed with CVI as compared to occular disorders. We have 9 teachers in our district⌠almost all have been through TVBI training programs with in the last 10 years (most in the past few). CVI is talked about minimally and teachers are not trained to do assessments and evaluations. We have one teacher who has taken several classes in just CVI and does our assessments. It is so needed⌠hence why I am doing this class during the summer to learn more!
What a great idea! Developing the classroom as âCVI friendlyâ is so important. This also includes at home. I had a young student that had a CVI diagnosis and was literally not playing with toys. I asked mom if we could put black sheets on the toy cupboards and some of the other clutter in her living room. I also encouraged one toy at a time. Within a month she was playing with all kids of things. Environmental clutter is a huge thing!
Totally agreed! I have had a few students that absolutely love blue!!
- To what extent do existing professional preparation programs (across fields) equip practitioners to understand and serve students with CVI?
As a relatively recent (3 years) graduate of a graduate program in Speech-Language Pathology, I feel very strongly about the answer to this question. In my program (which was a medically focused program), my AAC professor took time to not only introduce us to CVI but to take a seminar-lite version of a seminar she took from Dr. Roman-Lantzy. I was thankful that I then did my school placement at USDB (the Utah School for Deaf and Blind), where I got to experience CVI in âreal lifeâ.
However, much like communication disorders/disabilities, I didnât feel like many programs outside of my specific program (MS SLP), TVI, or COMS give much attention to CVI, unfortunately. I also think that so many professional practice programs have to cover so much material that the specifics of specific disabilities get left out and it isnât until we have real life experience that we are able to conduct our own professional development.
Interested to hear everyoneâs opinions on this.
- Katherine
I 100% agree with youâŚour opinions and expertise are very intermingled. I recently had a call with a parent of one of the kiddos on my caseload because he has significant interfering behaviors at school (think throwing, hitting, pinching, etc) but also doesnât yet have a system of symbolic communication. He isnât a candidate for direct select on an AAC device or true tactile discrimination. He has CVI, spastic CP, is wheelchair bound, etc. I spoke with mom (I am the new SLP taking over) about her frustrations from previous SLPs and his current communicative abilities. We ended up deciding that once or so a month, Iâd go see him on a home visit because his motivation to communicate at home is SO MUCH HIGHER. Hoping that this not only sets the pace for a good relationship with family, but also encourages the kiddo to communicate.
Hi there!
As an SLP, I love that you used a speech example. This is an issue in so many speech-related programs because (as I said in my own post) while my program did include a CVI discussion, there are so many that do not! Of course the SLP was trying their best, but it obviously wasnât working with vision. I loved that you were able to collaborate with one another and encourage the SLP to work better with the student. We canât do better until we know better.
Katherine
Totally second this perspective! In our school, teachers have been trying to implement home-visits (alongside the assessment and instruction that happens during the school day). Weâve found that though itâs a bit more challenging and time consuming, it can unlock hidden information not typically caught in your standard intake form or survey from parents. Plus, being in the students home environment helps instructional staff pick up on subtleties and routines (or lack of routines) that the students use at home.
For example, one of our students with CVI had a home visit and we found out he doesnât use his wheelchair at home, which limits his activities and communication and routines - thatâs not something we understood from just meeting.
This all boils down again to the collaboration youâre shedding light on - it can be so critical!
Weâve seen similar positive results doing home visits with our students! Helps close the gap and address all areas of the childâs routine!
Question 3: 3. 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?
I think of a particular student, GK, with CVI who is very light and Motion stimulated. He does great independently navigating a tablet for chosen activities, and I thought because of this we could work on a iPad game meant to explore cardinal directions using swipes and sounds.
Quickly after starting, we realized the IA needed training first on how to support the learning without taking over. Sometimes, that is the simplest strategy, but most forgotten if Iâm being honest. We also found that his classroom environment was hindering the learning process: he had 7 other students in 1 room and everyone was working on differentiated instruction, which lead to a loud and cluttered environment. The game was auditory, but we also learned that the sounds didnât motivate the student, so he was more interested in getting a wrong answer because he liked the âerrorâ sound. All of these circumstances were a slow learning process. We eventually tried the activity in a quiet room, 1-on1 with headphones, and began with some tactile models of directions to reiterate. The students scores increased, but Iâm not proud of how long it took. It also raises the challenge of what are teachers supposed to do in when environments that arenât ideal / overstimulating are uninevitable? We have been slowly working on this and I would welcome any suggestions! 
As a TVI in a IU in PA, I had a student who was Phase 3 CVI and in taking Matt Tietjanâs class âWhatâs the Complexity?â who was failing all his specials classes due to his behavior or lack of behaviors. I had spent time in his educational classroom since he was in 3rd grade did not change classes for instruction. I collaborated with his teacher and special education teacher to make the classroom more âCVI friendlyâ which in turn helped his classroom peers also. The teacher embraced my bi-weekly visits and new information. Since we were successful with his educational classroom, the principal asked if I could do something about his specials. I observed each and he was my case study for Mattâs class. I was able to come up with accommodations for PE, Art, and Library. Music was not a problem because he was allowed to move around. The PE class was both in and out side and my friend had problems seeing the ball in the air, the complexity of the gym(sounds, colored walls which I could not change, and many directions) and the depth of the fields where they played different sports. I collaborated with the PE teacher and we were able to come up with different balls and sunglasses for him to use outside, inside we used noise cancelling headphones to block some sound clutter and they used his name for directions. Library was a little harder as you canât change much in the library, however it was a smaller school so we used velcro curtains to block some of the book shelves. The librarian had posters that moved so we sat him with his back to those yet the other kids in the school were able to use them. Using block out masks for his reading like we used in his classroom worked when he had to pick a book from the shelves. Now Art class was no a success. The teacher did not want to change her environment for this student. The complexity of the environment was overwhelming to me as well as other students however she was set in her ways. I suggested doing some black out areas for him to move to when it was too overwhelming. Well when I went back in she had secluded him into a total black area away from the other students and away from her instruction. She gave numerous verbal directions at one time and my student could not differentiate what she was saying in combination with the classroom noise so he threw his paper and drawing materials. The moral of this is that you as an itinerant TVI I made recommendations using the knowledge from âWhatâs the Complexityâ framework, but they did not work for all educational settings for my student. All in all I am glad I was able to complete the classroom modifications for most of the specials and his educational setting.
HI William, I, too, have a scheduled training with my classroom teachers and staff where I normally provide a written statement of the studentâs diagnosis, strategies to use, and accommodations that should be followed for academic success. At this time, I have kids from 1 to 12+ in a variety of schools so it is important that each team has the written material to fall back on when I am not available. I supply services to a whole county with other colleagues so we are spread a little thin. We as a team try to use the same terms when going from school to school also for CVI and other VIs.
- 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?
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I loved reading the blog post by Dr. Amanda Leuck. It makes me think of all the plans I have made before meeting a student. Although these plans help alleviate the first-day jitters of meeting a new student, I almost always have to pivot âif not on the first day (or sometimes the first hour), then on the second day, third day, and so on.
My first teaching job was at the TSBVI, where I taught in the EXIT (Transition Program) with students who have multiple disabilities and high support needs, requiring creative solutions for transition planning. Students who came my way had 18+ years of school experience, which in some cases meant 18+ years of a âreputationâ-- for better or for worse. Many of my students had behavioral support needs, and at times, complex communication that required careful attention to understand and respond to. As a first-year teacher, I combed through paperwork, reading about every behavioral incident. Highlighting. Underlining. Making plans and becoming nervous over students Iâd never met, asking myself âwhat will the first day look like?â over and over again. The words âCVIâ kept popping upâall I knew was to present things on a black background, but CVI felt like the least of my concerns amid everything else I read. At the time, I didnât fully realize the impact of CVI on all the listed areas of need.
As Iâve progressed through my career and spent time learning about CVI, it has become much easier to identify the impact of CVI on a studentâs access to education. When I first moved to Wyoming and became a TVI (a role that hadnât been filled in years in the town I moved to), I initially encountered many teachers who likened CVI to selling snake oil â my impression was that people didnât fully buy into the idea of CVI-- of course I say that understanding that they were seriously deprived of any vision-related training. Fortunately, 4 years later, thereâs a crew of teachers in this district who are on the lookout for CVI (seriously, amazing!!).
The first example that comes to mind when I think about misconceptions about a student occurred with a student I met when I moved to Wyoming, in my first year as an itinerant TVI. She was 16 at the time-- she had CVI and additional ocular impairments as well as additional disabilities. She uses full-body movement and vocalizations (such as crying, laughing, etc.) to communicate. At the time, an IEP goal was written for her to demonstrate âcompliance with hand-over-hand instructionâ; she also had a goal to ânot cry during instruction/hand-over-hand.â Naturally, that hurt my teacherâs soul to read. An administrator even told me not to spend too much of my week with this student âthat the student had made very little progress in the school system and was essentially a lost cause (said in softer words, but this was the clear message). After spending time observing and getting to know this student, it became apparent that simultaneous sensory input severely impacted her vision, often completely cutting off her visual access. Loud noises in the classroom or outside would result in her covering her face, standing up, and âroamingâ the room, crying or screaming. Physical touch (hand-over-hand, pushing her forward while walking to âkeep her movingâ) had the same result. Often, it could take over 20 minutes for her to re-regulate, but unless the competing sensory stimuli were removed, she could not regulate.
Viewing her responses as ânegative behaviorsâ removed the curiosity and wondering why she was responding this way; more obviously, it completely ignored her diagnosis of CVI. Her responses were labeled as âtask avoidanceâ, a misidentified behavior that was not explored or understood. So many things, including a change-up in staffing (unfortunately, the initial teacher did not change his stance on CVI) have taken place to support the student over the past 3ish years. We needed to rebuild her trust and give her the control she had previously lacked. A huge win happened this past year, when the student initiated hand-under-hand for the first time in the four years Iâve worked with her. She also consistently completed a 30-minute routine because the environment and materials met her needs. I hate to admit it, but I wasnât fully sure of where things could go with this student. Iâm still in awe of how she continues to grow, both in her confidence and communication (and beyond).
Another key takeaway from this article is the importance of spending quality time with students. When I meet kids for the first time, especially those with more complex needs, I always try to spend a few of our scheduled times together following their lead or engaging in a preferred activity with them. Often, when I walk into a room to meet a student for the first time, a teacher will say, âTheyâre ready to work for you!â-- I have to remind myself that the most valuable way I can spend my time with a new student is to get to know them, to observe them, and to learn how to support them-- to try and have FUN with the student. As a teacher, tossing my âagendaâ or other peopleâs expectations of me to the side can be hard and make me question myself, but this article reminded me of the importance of doing just that. When we follow a studentâs lead, we learn a great deal, and as a bonus, we can build trust, establish rapport, and demonstrate to the student that we are listening.