@lshortis Just love that students can be their best advocates! For example, the student who suggested that the nest needed color. As someone who can see “more” colors than most can traditionally see, hearing the student need color makes so much sense to me. Even better is getting to hear the story from you because it’s clear the impact of that statement lasted with you.
SMG
@Rachel_Otremba It’s interesting to see how best practices for all learners helps students with CVI, too. For example, when you discuss how to support participation in the classroom or daily activities. Many students like to be able to understand the change and the WHY of the change. By providing this type of knowledge to them, students of all abilities are able to internalize changes more effectively (even if repeated instructions are needed).
SMG
A one-and-done approach to assessment tasks is not reliable and does not respect the individual child. I loved the example of the “pink sippy cup” presented during unexpected activities and times, and presented with the absence of some modalities such as sound (voice), to ensure that the child makes the cognitive connection along with visually recognizing the item. This would be easy to do in a natural environment with routine activities, and give the observer invaluable information about the readiness for 2D presentations.
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Current multi-method assessment strategies (such as structured interviews, direct observations, functional vision assessments, and caregiver input) provide solid information on the student. These tools help capture how CVI affects visual attention, movement, access to learning, and visual behavior across environments. Although I feel that it does not provide the full scope of CVI’s impact in real-world contexts such as home, community and unstructured learning environments. I think it would be beneficial to incorporate behavioral and emotional observations to evaluate behavioral responses to visual fatigue, changes, & overload. I have observed a few of my students in an unstructured environment (i.e. a school community event – field day, talent shows, health and wellness fairs, etc.) and have noticed changes in their visual behaviors which then causes emotional dysregulation.
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I’ve had the same experience with students use Core boards and other AAC devices where the images are tiny and there are so many pictures on each page of the board. I’ve always worked closely with the related service providers esp. the speech therapists to figure out the best way to present these items to students with CVI. Many speech therapits I have worked with also have never heard of CVI and were not aware that visual clutter can really affect these students.
I think your multi-method approach to find CVI patterns across different observers and testing situations are a great idea. When working with my students with CVI I am constantly speaking to their related service providers, teachers, and parents to see if they have also noticed the same things I have. I also think observing students in an unstructed setting can be helpful in providing new information.
I love interviews and observations. I love asking questions to parents, teachers, and classroom aides. I will also interview the PT and OTs if they are available. If I have time to make up with a student and it coincides with a PT/OT session, I will sit in, take notes, and collaborate. This interaction is great because we get comfortable with each other, and this has led to collaborations and brain dumps for our mutual students.
I thought the mention of behaviors was worthwhile as well. You addressed some very valid points. "When CVI is identified and well managed by parents, caregivers, teachers, and students themselves, behavior issues abate and the child learns and thrives. Behaviors are key elements in identifying underlying and sometimes challenging issues with all students. All behavior, in my opinion, is communication and is purposeful, regardless of whether it is positive or negative. Too many things might get overlooked or misread without appropriate screening and assessment. I enjoyed your post.
Our job is to make learning materials accessible for our learners. The 2D Image Assessment brings attention to the importance of determining what our student can and cannot identify. The majority of my caseload are students with multiple impairments and many cannot verbalize wants and needs. The use of AAC devices have increased and I love working with the SLPs in the building. Like others have said, I can get black backgrounds, but my students are mostly stuck with color illustrated symbols. I have gotten photographs of classroom objects and people added to some tablets. With time, I think this could be successful. I like bringing devices on O&M routes so that s/he can identify people or objects in the school environment.
- What are the implications of relying on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors?
As a TSVI, I do my best to be aware of and try different assessments that are available to identify the impact that CVI may have on the children that I serve. I have spent significant time in the past studying the CVI Range and for the past year have been diving into the Perkins CVI Protocol. Now I am here trying to learn more about the CVI Companion Guide. A thing that I have noticed as I compare and contrast these tools is they are often looking at the same or very similar behaviors or characteristics. For me, when using these assessment it is easy to see how these characteristics manifest in children who are greatly impacted by CVI, but it much more difficult to tease out how children are affected when the severity is low and impact more subtle. The implications of this are, as the reading states, that “only the children with the most profound cases of CVI are identified during the early stages.” We know, based on recent research done by Perkins School for the Blind (https://www.perkins.org/our-work/cvi/by-the-numbers/) that CVI is significantly under-diagnosed, with only about 20% of children likely to have CVI receiving a diagnosis. With the assessment tools that we have, I find it difficult and time consuming to accurately determine where the threshold for some of the characteristics, especially complexity, lie with those children who often look like they are using their vision well.
I think it is especially difficult with the current population (under the age of 3) that I am working with. Many times, I get asked to screen a child for CVI who has medical risk factors, often HIE or prematurity, just to rule out vision issues. In this process, I obviously find those that are unable to use their vision functionally, but I also feel like often I see children who seem to be using their vision in an age appropriate way. I worry that with their brain history they may experience some visual impacts when they are school age that we can’t be aware of yet due to development and language skills.
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Analyze how individualization of the 2D image assessment might lead to more accurate conclusions about a student’s needs. What variables (e.g., cultural relevance, personal familiarity, sensory preferences) should be considered?
Individualization of the 2D image assessment will lead to more accurate conclusions about a student’s needs in many ways. The 2D image assessment addresses accessibility. Color photographs of familiar items may be what Student A can identify whereas Student B can identify color photos and illustrations, but not black and white images. It is relevant to academic needs. Cultural relevance is important to consider. I have a kindergarten student with multiple impairments from a Nepali household. She does not speak, and she is learning how to use eye-gaze for her AAC device sitting on the desk (wheelchair mount is forthcoming and is anticipated for the fall). For O&M, I am reviewing body parts. As she watched a cartoon body parts video in Nepalese, I touched her body part when possible and stated the English equivalent. I know that she enjoys Cocomelon cartoons based on parent feedback, but I was unsure if she understood what was presented. Personal familiarity reminds me of visual novelty…if my student were content watching Cocomelon, it was plausible that a cartoon in her native language would be tolerated. It is challenging because my student was introduced to AAC this year, so she is not accurate in her responses. This ties in with the 2D assessment nicely because we all need to understand what imagery is accessible. Her ACC device has mostly color illustrations. Now that I think of it, she is good at finding her brothers on that device and their pictures are the buttons. I do not think the folder that contains the family has a photograph, though. I will mention this with her new SLP as her previous SLP retired. Regarding sensory preferences, there is a lot to consider: environmental complexity (noise levels, lighting, movement of others) and tactile considerations. Would Braille help with that? I have not had the opportunity to try with my students. I have a lot of throwers. In conclusion, ongoing assessment of 2D imagery is important for students with CVI. The more we know, the better we serve.
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Analyze how individualization of the 2D image assessment might lead to more accurate conclusions about a student’s needs. What variables (e.g., cultural relevance, personal familiarity, sensory preferences) should be considered?
One such variable that arose with one of my students was she is non-verbal. One component of the 2D image assessment is the student having the ability to state, “What do you see?” At the time, the assessment initially began, the student was not proficient with her AAC device. In order to begin at assess her ability to see 2D images, the images presented were paired with 3D objects. Initially, some instruction was provided to ensure the student was able to identify the objects. After demonstrating confidence with the 3D objects, she was then asked to identify the images using the 3D objects. While the information obtained differed from the protocol, the student was able to provide clear patterns in the images she appeared to recognize.
Fast forward one year, the assessment was conducted again with the student. The images presented were animals. However, this year, she is much more skilled with her AAC device. This time she is able to look at the individual images and find the icon on her device. This time, the question could be asked, ”What do you see?” and she was able to respond. This was a huge moment for both student and teacher.
The individualization of the 2D image assessment lead to valuable information regarding the types of images she was able to recognize and led to more accurate accommodation of her classroom materials and environment.
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- What are the strengths and limitations of using task-based observation as a primary method for CVI assessment, particularly in comparison to more objective assessments?
Task-based observations as a method for CVI assessments has a lot of strengths including to analyze and observe how a student interacts visually with a functional task. It is individualized and flexible to meet a student’s unique needs. Using task based observations can lead to immediate feedback that can also capture information for interventions or accommodations that is missed on objective based or standardized assessments. With all the strengths of task-based observations there are also limitations; subjectivity, difficult to compare data, gaining limited quantifiable data, and also time consuming in the greater scheme. However, it is so important to remember while every child is unique, diving into understanding the functional vision a student has to complete a given task is more essential than making a choice they may have heard auditorially.
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Your experience supports this information on how the important it is for the students to be able to access 2D images in order to effectively access an AAC device. Collaboration is so essential and your example and the findings are just giving in more validity.
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I agree it is so important to know if a student is able to access a 2D image or requires a 3D tactile tangible object to gain meaning and recognition of the object, then we must met the student where they are and cause more daily frustration and confusion. The 2D assessment would be a part of both the FV/LMA because in the functional aspect the student is able to imply meaning of an image to a real world object, that has meaning or purpose to them thus increasing communication. For the Media assessments it is essential to know if the student is truly able to access the 2D images, so often the objective or standard assessments may have 2D complex images that the students can not visually access this is not measuring their ability but creating an additional barrier to them being able to access the information presented to them.
First, I fully recognize that this is a growing and developing repertoire of standards/tools to begin to capture the complexities of CVI. And because each student is unique with their own journey and history, as TVIs and other professionals supporting them it is I think critical that we always keep in mind that there isn’t (at least not yet) a definitive “yes/no” system. And it doesn’t seem likely that this will be a possibility even with all of the amazing research happening around CVI. There are so many shades of this and how it presents, but that is also part of what I find so fascinating and challenging!
I have been working with a young kindergartener who has strabismus and wears glasses for that and to correct refractive error. He had significant brain trauma upon birth (brain bleeds and subsequent seizure activity) but does not have a diagnosis of CVI. He is unable to copy any lines, shapes, patterns and is struggling with reading and essentially anything that requires visual motor skills. If you draw a “C” he cannot reproduce it for example. Because his team knows me I was asked to meet him and do an assessment to try and find some supports for him. He definitely does not present with “typical” CVI characteristics so the team is reluctant to fully consider CVI. His ophthalmologist did not identify it either. So that leaves me feeling strongly that especially considering his medical history that this is most definitely in play for him.
I mention this particular situation because for me it highlights the lack of “bandwidth” of schools/families to sometimes acknowledge CVI - even if the student doesn’t have color preferences or makes eye contact or other “expected” characteristics. I believe as the professionals in the field who experience the nuances of CVI that we need to absolutely utilize the current assessment frameworks but also listen to our experienced inner voices - even without an official CVI diagnosis, so many of our students could benefit from strategies to mitigate it’s impact. I am encouraged to be hearing of the work being done to include a broader cross section of students who present with ADD/ADHD, ASD, CP, etc. to consider that CVI might be a reality for them as well - in a way that is unique to them.
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- What are the implications of relying on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors?
When I began my TVI career over a decade ago, I found myself overwhelmed that there was no “true” standardized way to assess students with CVI. I had always been a “by the books” student who followed a prescribed protocol. Once I started conducting FVAs, LMAs, and CVI Assessments, I realized why there was no single, standard way to assess my students and their vision. Each student is unique in how they visually interpret their environment and the approach on how to assess them visually needs to be dynamic and fluid.
The implications of relying on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors is, according to Dr. Lueck, that "many children with [CVI] of all ages fly ‘under the radar’, remaining undiagnosed, underdiagnosed (with many CVI features being overlooked), or even misdiagnosed. This could mean that a child that doesn’t exhibit a specific visual behavior according to an assessment, may be misdiagnosed and continue to struggle visually without proper modifications and accommodations in place. Additonally, Dr. Lueck et al, write .. “while more validated and sensitive assessment tools can be anticipated, we still must be alert to the need to treat each individual with CVI as unique, since the age at onset, location and extent of the [brain damage], and other factors lead to wide ranging behavioral outcomes.”
Overall, in order for students to not “fly under the radar” in regards to missed/misinterpreted CVI behaviors , Lueck suggests “…remaining open to unanticipated subtle behavioral variations being revealed during the assessment process, although not picked up by specifically targeted assessment tools.” As a TVI, I must continue to research CVI resources and their use to ensure the whole child is represented. This also means that I should continue to assess the student across many different environments at different times of the day to gain a holistic view of the student and their visual tendencies.
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Hi, Crystal! I agree with you regarding your statement of task-based observations, in that while this particular assessment option is subjective and difficult to compare data, the information gathered offers specific and unique information for the student being observed, as one is not necessarily comparing the student to anyone else who may be doing the same task. In such a way, having this information may allow service providers the opportunity to obtain information which may not make itself known by means of any other assessment option. When I am evaluating a student, I always try to do at least one observation in their natural school setting first before I do any individual assessments. I feel this not only gives me an opportunity to gain an initial understanding of their current functional vision, but it also may provide unique information as to what the individual student may already be experiencing difficulty with.
One of the strategies I have used is to pre-teach the images to a student before they are presented in the regular education classroom. This particular student is a first grader whose ELA curriculum is very image dependent. Typically, new lesson was introduced on Monday. On Friday, we would preview the images that were going to be presented the next week. I would isolate each image in a PowerPoint presentation with a black background. For each image we would discuss what the image was and its salient features. It was really interesting to see her responses regarding what the image was initially. This particular curriculum utilized the same images in later units so once an individual image was in her “visual library” she could recognize it later. I also observed her participation increase knowing she could identify the image in question.
Megan, I agree this it is really important to be able to collaborate on a regular basis with the other related services. I also appreciate being able to see the student in other environments and observe how they interact with the materials being presented outside of when I typically see them.