I agree. I’ve also seen a wide range of approaches to assessing students with CVI, and it’s true—no single tool has ever captured the full picture. This course has really helped shed light on how we can make our reports more meaningful and actionable for both teachers and families. Like you, I use different methods and adapt it to fit the unique profile of each student. What has stood out most for me through this training is the importance of simplifying our language and recommendations so that our reports don’t just check boxes—they actually support collaboration and implementation.
Assessing 2D image recognition for students with CVI
2. 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?
I feel it is very important to have familiar and meaningful images when assessing students with CVI. To me this is a critical reason why the VI should always assess first and have their recommendations reviewed before other evaluations take place. (I realize this is best practice but unfortunately it does not always happen. Staff is busy and overwhelmed with testing.) Too often, when SLPs or a diagnostician try to test a student before understanding the student’s visual needs, the results can be misleading. The issue isn’t always the student’s ability—it’s the nature of the images being used.
If the images are unfamiliar, abstract, or visually complex, the student may appear unable to complete the task, when in reality it’s a mismatch between the material and how the student accesses information visually. Individualizing the 2D image assessment to reflect the student’s actual experiences, preferences, and cultural background makes such a difference—not just for communication devices, but for accurate assessment outcomes overall.
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I can relate to so much of what you described. I’ve worked with a students who have had dorsal or ventral stream dysfunction, and the need for consistent environments, clear auditory cues, and simplified visuals was essential. It really does take thoughtful planning and collaboration to help others understand that “seeing” doesn’t always mean meaningful visual access. I appreciate how you explained that to your team—it’s something we constantly have to advocate for.
I totally agree. I am a trainer for INSITE and VISSA and after presenting on CVI, some teachers and parents will say "I think my kid has CVI or many behaviors that are similar. I love that the article mentions behaviors that are on the spectrum of CVI.
It is a great way to learn how they are understanding the world and concepts. I just had a student who after listening to the story Three Little Pigs asked if it was straw that you drink with. The picture of a piece of straw could look like a drinking straw if you haven’t had experiences with straw of this type.
In what ways do results of the 2D image assessment intersect with data collected for the Functional Vision and Learning Media Assessments?
The images used in the 2D assessment align with data collected from the Functional Vision Assessment (FVA) and Learning Media Assessment (LMA) by offering insight into how, what, and where the student visually processes information. For example, the picture of the cat appears in two versions: one in black and white, where the cat is gray, and another in color, where the cat is orange. The student may more easily recognize the orange cat due to its higher contrast, which can inform us about their visual preferences and needs.
Additionally, the facial expressions of the cats differ—one is smiling while the other appears confused. This subtle detail can provide further information about the student’s ability to interpret facial cues, adding depth to the assessment of how they are seeing.
As noted in the article, “For many with CVI, compensatory skills (e.g., color coding, tactile and auditory cues, memory, and context) support recognition.” By presenting only a visual image—without accompanying sounds or tactile input—we can evaluate whether the student relies on multisensory input (e.g., sound or touch) to identify familiar objects like a cat, or whether they can use their visual system in combination with prior knowledge for recognition.
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Hello Nazanin. While I have several young people on my caseload who have a diagnosis of CVI, there is one in particular who I’ve run square into an SLP who (by her own admission) isn’t “comfortable” with a student with the level of complexity that this kiddo has. He is Deaf as well (since birth has had no auditory input), so that sensory channel is completely unavailable. As lovely a person as she is, she (SLP) is trying to force the use of an AAC device (iPad) and it has sadly become a bit of a contentious thing as this has resulted in the loss of ASL interpretation in his daily life.
So this discussion on 2D images is SO relevant! I’ve been trying to work with the team to share the need to intentionally continue ASL with him but they are going in the direction of “he will get it” … and I’m having a hard time staying in my TVI corner! This move away from ASL and towards a quite abstract symbols based communication strategy is worrisome. I think he can do it given a LOT of time, exposure and patience. But I know this coming school year I will be tapping into articles such as this for direction and likely also sharing with the family/team. It is a big responsibility to be shaping how a young person will communicate with their world!
Thanks for your post!
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Considering the role of fatigue, context, and environmental variables, how reliable are single-time assessments like the 2D image assessment in capturing a student’s true visual abilities? What alternative or complementary methods might yield richer information?
I think it is important to remember that the 2D image assessment should only be a part of the entire vision assessment. We should take into account all of the findings of the assessment when creating a picture of a student’s true visual abilities. In order to complement the 2D image assessment, I think it is important to get several observations in as many environments as possible. When it is not possible to observe in an environment, it is very helpful to get antidotal information from other adults who interact with that child.
Pulling from multiple sources and across multiple environments allows for a better picture of the child and can take into account if the child is having a bad day and experiencing more fatigue, etc which can impact their vision. While the 2D image assessment can provide a good picture of what the child sees in a controlled environment, we all know that this kind of environment is not always as possible. It is helpful to have an entire picture of the students overall vision in order to accommodate across the school day and for variables like fatigue, noise, lighting, etc.
That is such a great point of suggesting that the TVI be the first to assess. I think it can be very eye-opening when the entire team is able to come together to discuss a child. Every member is an expert on that child in their own way and can bring bits of relevant information to the table to create a better overall picture of that child’s strengths and needs. It also helps to address cultural barriers, so everyone is on the same page.
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I agree with you William in that it is important to try to get a more collaborative, interdisciplinary assessment. Each discipline has a unique perpective that can provide valuable insight to giving a more complete, comprehensive picture of the student during all of their daily routines and environments. It seems this approach is common when assessing younger students (pre-k and early elementary) but is sometimes is less adopted when performing assessments on older students, who may be receiving their CVI later in their educational journey. (At least from what I am seeing, where I am located). So, like you, an interdisciplinary approach is something I wish could be more uniformly done during the assessment process.
This past school year I had an experience with an academic high school student and providing multiple observations across several class periods during the school day. We included these observations as part of the functional vision evaluation and LMA. They were very helpful to providing insight into many of the students behaviors-some related to vision. Doing multiple observations is not the norm for me, but I think when it is paired with the 2-D image assessment, LMA and EFVE then we can provide a true picture of the students vision.
The speech team at my school experiences this with speech and language assessments. Most (all?) assessments are not normed on students with visual impairments, which means that all of our assessments come with the caveat that “this data should be interpreted carefully” due to that fact. If we rely on current assessment tools that may not be sensitive to the full spectrum of CVI behaviors, then are we really assessing the whole student?
I would argue that no, we are not. Much like how students’ vision and visual needs change over the course of their educational experiences (and lives), so, too, should our assessments. If we do not, we risk undermining what a family is doing to help their student, we risk alienating a student for being “different”, and we risk further mis-identifying and/or misdiagnosing students. While yes, we are “only a school” and “can’t really do any harm” compared to our medical counterparts, I would argue that school absolutely can (and has) do damage to a student’s mental health, education ability, and overall well-being.
- Katherine
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Wowwwwwww, I have so many big feelings about this commentary. I would love to hear your thoughts further on this. It is hard because, as an SLP myself, it feels as though the world pushes us harder and further to technology, HOWEVER, it is still important to engage with multi-modal communication, in my opinion. I work with several Deaf-Blind students and using ASL and tactile and technological communication (read: switches/high-tech AAC/etc) is important in keeping our students from accidentally experiencing language deprivation.
I totally agree with you! Cultural relevance feels so important, especially in considering an assessment. In my undergrad, I did a research study on culturally relevant pedagogy and literacy levels…I found that higher culturally relevant pedagogy had a direct (and positive) correlation to literacy levels. I can only imaging that the same would follow with 2D image assessment.
- Katherine
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- Reflect on a student with CVI who showed signs of dorsal or ventral stream dysfunction. How did this impact their participation in classroom or daily activities? What specific challenges did the student experience? How did you adjust instruction or materials to support them?
Around the time that Vision and the Brain (Lueck and Dutton, Eds.) was published, I had a student who barely qualified for vision services. When I started his FVA/LMA, he seemed like a typical preschooler with some mild low vision, for which he compensated very well. He had very little difficulty with basic visual efficiency skills, and while observing him in his home, which was all one story, he moved around well, except pausing slightly at door thresholds and changes in some new floor coverings (replaced carpeting against refinished wood floor). However, as I began to observe him outside, I suddenly understood his mother’s concerns about “…the way he moves. It’s just weird.” He loved being outdoors and playing with his older brothers. The family lived on a good bit of land, and one of the activities this child enjoyed was running down a hill with his siblings. I observed that when he ran, it was at a right angle with his upper body bent over, and one of his brothers holding his shirt for safety. His mother stated that he always ran this way down any kind of incline. When going upstairs on the outside of a barn, he side-stepped up the stairs while clinging to the one rail. He also lowered himself to feel the change from the concrete driveway to a darker gravel path. He still hesitated when moving between the driveway and gravel and picked his leg up high before placing his foot on the gravel. His mother also had her son go into a part of a play tent/tunnel. The rectangular box-like portion he was in would have been easy to climb out of. However, he squatted at the bottom, and when asked if he wanted out, he only raised his hands up without standing. His mother stated that this was his reaction to any kind of small enclosed area. He did not appear to understand his ability to leave the area or to explore any part of it other than where he was squatting. He probably had some lower field loss, but his spatial perception, particularly as it related to his own body and visual guidance of his motor system, was extremely poor.
I had learned about Dorsal and Ventral streams through training for The CVI Range, but I knew there was more, and I searched through my new shiny copy of Vision and the Brain for more information. His problems had to be with his Dorsal stream and visual motor planning within the space around him. The mother talked with his pediatric ophthalmologist at the next appointment, but she dismissed the possibility of CVI, though she accepted the information I had sent with the mother. However, even without the diagnosis, interventions would be centered on the needs of the child. I began by having the parents ask for an O&M assessment and a PT evaluation, as I needed reinforcement and ideas on how to help this child enjoy the outdoors more independently. Unfortunately, he did not qualify for PT. I began working with him and his mother on “getting out of a box”. We started with the kitchen table, under which he also had difficulty removing himself, and removed all the chairs from around it. He and I got under the table. I had him grab the edge of the table with his hands, lower himself until his head was below it, and then walk his way under on his knees or squatting while keeping his hands above him and touching the underside of the table. This took a few tries before he was successful. We then played with his favorite trucks under the table. When it was time to come out, he used the same technique to get out; his cue to stand up slowly was when he could not feel the table above him. Gradually, chairs were added around the table. He learned he had power over the chairs and could push them out of the way. He then graduated to a box that had a closing door cut out at the bottom, and the ends of the box folded closed at the top. Opening and closing the bottom door was not as tricky, but standing up to open the top of the box proved a challenge. He felt that he had been put in a deep hole, and it was scary. With verbal prompting, he would reach and find the sides of the box and then work his hands up. Getting him to begin to stand was also challenging. He had no reference point above his head, as he had with the table. So…I got a shorter box, and this proved much more successful. His mother helped with obtaining a range of different-sized boxes, and over about 4 months, he finally stood up on his own to pop out of the original box. We had a party.
The O&M and I worked together to help him understand his body in space when there were no boundaries. We used balloons for him to hit with his brothers, and then balls (kicking and catching a short range at first) on flat areas and then gradually inclines. This forced him to reposition his body so that he moved with an aligned back, shoulders, and neck rather than bent when he was on an incline. With the stairs, we found out that he had never bumped down on his bottom or climbed up stairs. We had him learn the depth of the stairs with these tried-and-true strategies. Later, he was taught to slide his foot down while touching the back of the step as he descended. We continued to have him stop and feel transitions between ground surfaces and floors, but this was faded as he used a rolling pre-cane to help him understand the difference in textures so that he did not have to stoop down. He eventually did not need the pre-cane at home, but he was instructed on a long cane to use in unfamiliar community settings. CVI is different with each child, and sometimes the manifestations are not obvious. Understanding what we know about how vision is processed in the brain will help with observations and inform decisions about assessment activities. As Dr. Dutton said, “When you’ve met one child with CVI, you’ve met one child with CVI.”
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Jennifer, I love the points that you make. Because I worked for an agency that covered the entire state, I served several school systems. Many of them asked that I do the FVA/LMA first and then discuss it with the SLP, psychologist, PT, OT. I have even sat in on other assessments to assist with accommodations. I found that demonstrating the differences in responses to PECS vs. objects and photos/realistic pictures often convinced SLPs to rethink their assessment of students with CVI.
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Vicki, you are very correct about making sure that we observe emotional and behavioral responses with our students. I have used an assessment (Developmentally Appropriate Learning Media Assessment) that helps to remind me of making observations across all of the child’s daily routines. In those observations, I have documented any stressful situations that might be related to fatigue and/or frustration, and if there was a trigger. As much as we stress the importance of teaching independent living and self-determination skills, we sometimes forget that the emotions our students portray can be directly related to those around them failing to recognize cues of fatigue and increased frustration due to the fatigue. Kids aren’t going to learn when they are tired mentally and physically. I’ve always liked Matt Tietjen’s analogy of the importance of recharging the child’s battery so that learning can take place.
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Your comment about how children can appear to have normal vision, especially when very young is a thing that I struggle with regularly working in early intervention. I work with primary providers to screen children in their homes and at this point use a short question list (Teach CVI and the NAVEG (Neonatal Assessment Visual European Grid) as a basic FVA type screener. These will help identify very small children who are showing visual behaviors associated with CVI, but do not catch the children that are not severely impacted. All of the children that I do these screenings with have some sort of medical history involving the brain and I worry that though they are using their vision in an age appropriate way at this time, that when they are school age, vision issues will begin to arise. I don’t just want parents to think that the child’s vision is “fine” when I come in and screen and the screening tool does not indicate many CVI characteristics. I try to make sure to tactfully mention to parents that there may be visual differences associated with the child’s brain condition that may be noticeable later on, so they at least have heard it before and can keep an eye on potential visual challenges once they transition to school.
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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?
I think that relying on the current assessment tools that may not be sensitive to the full spectrum of CVI behaviors can lead to as the article stated a lot of children with CVI flying under the radar. I know that students can be misdiagnosed or not being diagnosed. Students will suffer due to not receiving correct or current services. I have seen this happen with a 3 year old I worked with in an early childhood setting. He had vision and was able to see objects, but as a TSVI I had not trained to do an FVA or an assessment on a student with CVI. Thus, he was not getting all the correct services he should have been receiving. I know now that we should have been looking for how his TBI, CVI, and language were affecting his learning.
I think this quote sums up what needs to be the focus moving forward:
On the other side of the coin, we know that when CVI is identified and well-managed, by ensuring that the child’s parents, carers and teachers, as well as the children themselves, understand how to circumvent and cater fully for the resulting visual challenges, behavioral issues abate and the child learns and thrives. [14]
As it has been stated: If you have seen one student with CVI, you have seen one student with CVI. Each present with different issues in different areas. As TSVI’s we need to know how to better assess students with CVI. Relying on what we currently have is one piece of the puzzle and we need to find all the pieces and make them fit to allow for the student to as stated thrive.
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I agree with your statements [quote=“lmcgookin47, post:4, topic:2311”]
I think the biggest change I would make to any assessment is to keep things as simple and understandable as possible. We get very lost in formal language as we write reports and lose the point of making our document clear and concise. I struggle with this as a professional as well when I am given information.
[/quote] A lot of times we muddy the waters and it makes it difficult. I too am taking this class to have a better grasp on how to assess a child with CVI. I do not currently have a student with CVI, but when I did I wish had a better way to assess for their learning.