Characteristics of

CVI
 Function of vision

 No one place in brain is responsible

 Organized in different places of the brain

 FUNCTIONAL USE OF VISION: Using
vision to complete an activity within
daily life
 Not based on
visual acuity

 Based on visual,
individual and
environmental
characteristics.
 What is CVI?

 CVI is a condition in which the eye works but

the part of the brain which interprets the
signals provided by the eye does not. This
will cause the child to have difficulty using
visual input he/she is receiving.

 CVI is not an indication of the child’s

cognitive ability.
 Differences between Ocular
and Cortical Visual Impairment

 CVI: child may see accurate visual image, but

can’t interpret it accurately
 Ocular: child has difficulty obtaining good
visual image, but can process and interpret
image accurately when enough information is
present
 Some children have both
(Levack, 1991)
 Let’s talk about CVI
 Child has difficulty using visual input
he/she is receiving.

 CVI gets better or it gets worse. It can

seem to vary from day to day.

 CVI is suspected when:

Normal eye exam
Brain injury
Unique characteristics present
Presence of the unique CVI
characteristics
 Characteristics of CVI

Early Resolution
 Light Gazing
Later Resolution
 Visual Reflex Response (touch)
 Visual Field Preference
Mid Resolution  Visual Motor
 Color

 Latency  Complexity
 Visual Novelty
 Target
 Visual Reflex Response (threat)

 Movement
 Array
 Complexity
 Distance Viewing
Light Gazing
 Staring at lights or light
sources is often observed;
may also be attentive to
ceiling fans.
 May be difficult to redirect
child’s attention away from
a light source.
 Sources of light should be
positioned behind child.
 When lighted toys or objects
are used the light should be
used to accentuate or
highlight the item. Toys
which have light and music
should not be used with
children in this phase.
 “Light Gazing/Non Purposeful
Gaze” Across Ranges
Range Range Range Range Range
1-2 3-4 5-6 7-8 9-10
May localize Less Light is
briefly but no attracted no longer
prolonged to lights – a
fixations on can be distractor
objects or
redirected
faces.
to other
Overly targets
attentive to
lights or
possibly
ceiling fans
 Color:
 Items typically need to be a single color.
 May need to use child’s preferred or favorite color.
 Once child is looking at a variety of single color items may
need to use favorite, or preferred color, to initiate looking
when child is tired or engaged in activities which may
challenge other areas (i.e.: motor) at the same time.
 “Color” Across Ranges
Range Range Range Range Range
1-2 3-4 5-6 7-8 9-10

Objects Has a Objects More No color or

pattern
viewed “favorite” may have colors, preference
are color 2-3 colors familiar
generally patterns
single regarded
color
Latency
 In Phase I it may take the child extended
periods of time to demonstrate a visual
response.
 Child may demonstrate a delay in using vision
to “look at” a target most of the time when a
new item is presented or a new activity starts.
 Allow the child multiple opportunities and
extended periods of time to demonstrate a
visual response.
 Latency may decrease as the child uses
his/her vision more.
 “Latency” Across Ranges
Range Range Range Range Range
1-2 3-4 5-6 7-8 9-10
Prolonged Latency Latency Latency Latency
periods of slightly present rarely
only when
resolved
visual decreases present
latency after student is
tired,
periods of
stressed,
consistent or over
viewing stimulated
 VISUAL NOVELTY
 Children prefer familiar
items over novel items.
 May ignore something
that is novel.
 Very different from ocular
impairments, in which
something new will attract
attention.
 “Visual Novelty” Across
Ranges
Range Range Range Range Range
1-2 3-4 5-6 7-8 9-10

Only May Use of Selection Selection of

objects not
favorite or tolerate “known” of objects restricted
known novel objects to less
objects objects if initiate restricted,
solicit they share looking requires 1-
visual characteris sequence 2 sessions
attention tics of of “warm
familiar up” time
ones
 Visual Reflexive Responses
 Visual Reflexive
Response
 Response to Visual
Threat
 Visual Reflexive Responses

Range Range Range Range Range

1-2 3-4 5-6 7-8 9-10

No blink in Blinks in Blink Visual Visual

response response response to threat reflexes
touch
to touch to touch consistently
response always
and/or but present. consistently present,
visual response present resolved
threat may be Visual threat (both near
latent response 90%
intermittently resolved)
present
MOVEMENT

 Objects viewed
have movement
or reflective
property

 Way to jump-
start visual
system
Movement

 Movement may be needed to initiate

and sustain visual attention,
regardless of how brief.
 Objects which provide the appearance
of movement can be used to initiate or
sustain “looking” (i.e.: toys which
have shiny or reflective properties
such as mylar).
 “Movement” Across Ranges

Range Range Range Range Range

1-2 3-4 5-6 7-8 9-10
Objects More Movement Moveme Typical
viewed consistent continues nt not responses
generally localization, to be an required to moving
have brief fixations important for targets
movement or on factor to attention
reflective
movement & initiate at near
properties
reflective visual
materials attention
Visual Fields Preference
 Child generally shows a field
dependency or preference. They
have a place where there “best
use of vision” is noted.
 Child will typically use peripheral
vision. May briefly try to use
his/her central vision.
 Child often appears to be “looking
through” people or objects.
 “Visual Fields” Across
Ranges

Range Range Range Range Range

1-2 3-4 5-6 7-8 9-10
Distinct field Shows Field May Visual fields
dependency visual field preferences alternate unrestricted
preference decreasing use of
with familiar right and
inputs left visual
fields
Visual Motor
 Visual targets need to be simple, non-
complex, because it is probably too
difficult at this point to use his/her
vision and demonstrate a motor
response (i.e.: reaching) in Phase I of
resolution.
 In Phase I child typically does not use
a visually guided reach.
 “Visual Motor” Across
Ranges

Range Range Range Range Range

1-2 3-4 5-6 7-8 9-10
Look & Look & Visually Look and Look and
touch touch on guided touch touch
occur as smaller reach occur in consistently
separate objects with rapid
functions. that are familiar sequence
Large familiar, objects but not
and/or lighted, or always
moving or “favorite” together
targets reflective color
Complexity
 Remember that visual complexity not only
includes what the child is looking at (visual
clutter), but any form of sensory input which
is occurring.
 In phase I items need to be presented
against a solid black background.
 When working on a child’s vision in phase I
the child needs a quiet environment to work
and play in.
COMPLEXITY

 Complexity of
target/object

 Complexity of array

 Complexity of
sensory
environment
Complexity of Target/Object
Complexity of Array
Complexity of Sensory
Environment
“My Mother in Three Rivers
Stadium” (Chris Roman)
 “Complexity” Across Ranges

Range Responds only in strictly controlled

1-2 environments.
Range Visually fixates when environment is controlled.
3-4
Range Student tolerates low levels of familiar
5-6 background noise.
Regards familiar faces when voice does not
compete.
 “Complexity” (cont.)

Range Competing auditory stimuli tolerated during

7-8 periods of viewing - student may now maintain
visual attention on music toys.
Views simple books/symbols.
Smiles at/regards familiar and new faces.

Range Only the most complex visual environments

9-10 affect visual response.
Views books or other 2-dimensional materials.
Typical visual-social responses.
DISTANCE VIEWING
 Often problematic for
children in early phases
 In Phase I child typically
only responds within 18-
24 inches of his/her
face.
 May be result of
increased complexity of
visual array
 “Distance Viewing” Across
Ranges

Range Range Range Range Range

1-2 3-4 5-6 7-8 9-10
Visually Occasional Visual Visual Visual
attends in visual attention attention attention
near space attention on extends extends to extends
only familiar, beyond 10 feet with beyond 20
moving or near space, targets that feet
large up to 4-6 produce Demon-
targets at 2- feet movement strates
3 feet memory of
visual
events
 Progression of Resolution
 Early Resolution
Light gazing, blink reflex

 Mid Resolution
color, latency, novelty, visual threat, movement
 Later Resolution
Field, visual motor, complexity, distance
viewing
Assessment Framework

 Interview

 Observation

 Direct
Evaluation/Interaction
with Child
CVI Range

 CVI can be severe, moderate, or mild

 Phases (I, II & III) describe broad
functioning levels
 Number ranges (0-10 scale used in
assessment) describe specific levels
of functioning
 Phases guide intervention strategy to
support best visual functioning
 Ranges

0 to 10 scale
0 = no functional vision
10 = typical visual functioning
 Correlation with phases is approximate

Phase 1 0 to 3.5 score

Phase 2 3.5 to 7.5 score
Phase 3 7.5 to 10 score
 Interventions
 “Environmental engineering”
 Based on individual child/student
characteristics
 Support the best vision where the child is
functioning NOW
 Learning to use vision
 Remove, decrease supports to environment
as progresses through to “resolution” of CVI
characteristics
 Phases

 Phase 1 : building stable visual function

 Phase 2: integrating vision with function

 Phase 3: resolution of CVI characteristics

Phase I
 Students generally require:
1. Single color objects
2. Objects of preferred color
3. Objects that produce movement or are shiny
4. Objects presented against a simple
background
5. Objects that are familiar

-Roman-Lantzy, 2005
Phase 2

 Students generally require:

1. Reduction of information when presented in 2
dimension
 Use occluders or window cards to eliminate
excess detail
 Highlight or outline critical features of symbols or
pictures

**Students should be at least a ‘7’ on the CVI Range

before asking them to discriminate 2-D objects**
-Roman-Lantzy, 2005
Phase 3
Students generally require:
 For complexity visual field considerations in highly
novel and/or over-stimulating environments
-Orientation (verbal & physical) to the
setting
-Assistance from an adult or peer
-Possible use of a cane
 In the classroom help the student think about their
thinking
 Focus on problem solving rather than specific
strategies

-Roman-Lantzy, 2005
 CVI in Infancy
 First three years are most critical for
permanent changes
 Early identification provides best opportunity
to take advantage of brain plasticity
 Don’t wait for medical diagnosis!
 Parents are best reporters about their
children
 Expect improvements
Impact of Sensory Loss
on Child Development
Always remember to watch for
signs of stress and fatigue!!
 Facial grimaces
 Hand and/or finger extension, opening,
and tension
 Light gazing and avoiding looking at
anything
 Yawning and/or “falling asleep”

 Hiccupping

 High pitched vocalizations

 Contact Information

 Annette Carey, Project Director

(304) 558-2696, acarey@access.k12.wv.us
 Ruth Ann King, Project Coordinator
(304) 558-2696, raking@access.k12.wv.us

Mentors
 Tammy Belt
Cell: (304) 646-1697, tbelt@hotmail.com
 Jamie McBride

Cell: (540) 533-8303, jmcbd27@hotmail.com

 Contact Information
Continued
Mentors continued:
 Bridget Bailey

Cell (304) 419-3187, Baboo6@aol.com

 Kathy Quesenberry

Cell (304) 952-1099, ques@citlink.net

Partners:
 Jennifer Cook

Cell (304)517-8767,jfostercook@aol.com
 Tina Foster

Cell (304)517-4079, tfoster@access.k12.wv.us

 Contact Information
Continued
Partners Continued:

 Kyle Heeter
Cell 1-304-573-4775,kylerae@opossumcreek.com
 Anita Nesland

Cell 1-304-614-3490, mnesland@skywayusa.net

 Amie Cook Smith

Cell 1-304-784-6873, amiejosmith@go.com