High quality Cortical Visual Impairment Assessments matter. Here’s why.


From Teaching Tips Tuesday


Jared Kittleson: Welcome to Teaching Tips Tuesday, my name is Jared Kittleson, I am Chief Operating Officer here at Foundation for Blind Children, and today I have the distinct privilege of welcoming Jonathan Graves to Teaching Tips Tuesday, Jonathan welcome!

Jonathan Graves: [waves] Hey Jared, thank you so much, thanks for having me [smiles brightly].

Jared Kittleson: Jonathan tell us what you’ve been up to, where are you, what’s your role–all the exciting things you’ve been up to.

Jonathan Graves: Sure, so I’m a teacher of the visually impaired and I recently started a new role at the Pediatric View Practice at the Children’s Home of Pittsburgh and Lemieux Family Center. I work on, uh, supporting children and families with cortical visual impairment and I help provide school support to schools who need some bolstering in the area of how to structure CPI accommodations. Um, it’s the new home of Dr. Christine Roman Lancy who has worked to develop the CVI range, so it’s an honor to kind of join her and work alongside her.

Jared Kittleson: That uh, you’ve had an exciting career, it’s been. it’s been uh, it’s been a joy to kind of watch you, uh, evolve over these last five years that’s for sure.

Jonathan Graves: [nods his head in agreement]

Jared Kittleson: So Jonathan, I understand we’re going to talk about the importance of CVI assessments–why, why are assessments so critical for students with cortical visual impairments?

Jonathan Graves: Great, yeah, so cortical visual impairment is a condition in which a child’s eye are taking in visual information, but their brain can’t process what they see, and unlike ocular impairments which tend to kind of static in terms of their impact, um, cortical visual impairments can improve with the right supports. So, we provide opportunities for children to visually access kind of the world around them and that–those accommodations differ depending on the impact of CVI. So, uh, we use the CVI range assessment which is a way of measuring what we call “The Ten Characteristics of CVI” on a child’s visual function, and by doing that assessment we, we can kind of sort children into three phases which helps us to determine what they need at school and at home to better see the world around them, and then hopefully, to help them improve their functional vision over time.

Jared Kittleson: So, Johnathan, you mentioned those three phases, can you talk a little bit more about those three phases and why those are, are important?

Jonathan Graves: Sure, yeah, um, so children who have, uh, you know, a recent–well children with the most impacted form of vision would be, um, kids who score between a zero and a three on the CVI range. Those children are in “Phase One” and in Phase One, you know, kids in Phase One tend to not show much visual attention to objects in typical environments. In order to support them we’re doing things like lowering the lights in the room, adding a ton of light to the objects–we want them to be using really bright color and specific color based on their color preferences. Adding movement and our goal is only to help them notice that an object is there and that they can attend to it. So, they may not know what the object is necessarily at this point, they might not have, um, you know, their interaction might be fairly slight, but we’re just encouraging the development of their visual system. In Phase Two, kids are gonna score between a three and a seven on the range, and Phase Two is all about, you know, kids in Phase Two might have more stable vision in more environments and they might show some recognition of really familiar objects, but we wanna help them understand how they can functionally be engaged with things by reaching for objects, by, you know, using their bodies to activate things around them based on what they see. And so, we also start to see that kids go, their-their, their sort of “Google Search Engine” of things they know grows a great deal. And they go from knowing only a couple of things to having a lot of these objects and people around them that are part of their environment that they recognize. They also can start to go from only using real objects that are three-dimensional to being able to interpret photographs of objects, or even more complicated images like a color illustration, or even a more abstract kind of, kind of drawing. So that process really takes time and it really takes some really specific work, um, by targeting the Salient Visual Features we call them, of every object. So, you know, we might start with a stuffed elephant and say “This elephant has a trunk and it has round ears and we can see those.” And then we take the child to a photograph of an elephant and we point out those same things, that’s kinda how it operates. So, as kids move up the range and we get into Phase Three we start to see that maybe that some characteristics are less important than they used to be. So, maybe a child in Phase Three doesn’t really have a color preferance anymore, they can see lots of different colors equally well. Um, and they start to be able to have enough discrimination visually and recognition to be able to get into literacy activities, so, we start to work with text with these kids. And, uh, we can use some different strategies to help them develop, understand the literacy, continue to refine how they process images, and, you know, broaden the number of experiences that they can participate in. We still have to provide lots of support but that happens in, you know, they’re using their vision almost all throughout the day and so there’s lots of chances for learning opportunities with vision.

Jared Kittleson: Excellent; Johnathan you know as well as I do, CVI becoming the prominent visual impairment in our younger population–what tips do you have–could be a parent, could be a fellow vision professional, a community member, what are some tips for someone who might suspect CVI but don’t have that diagnosis?

Jonathan Graves: Yeah, that’s a great question; so, CVI is officially diagnosed by an ophthalmologist or a neuro-ophthalmologist, um, and that–or a neurologist–and that diagnosis is made because the child has a history of neurological impairment, could be from many, many causes, but common ones include, you know, a seizure activity, a genetic disorder, a traumatic brain injury, could be any issue, things that happen during childbirth that caused some developmental injury. Um, and, you know, so that’s one important characteristic. Another diagnostic criteria is that, you know, a lot of kids with CVI will also have some ocular impairment, but that ocular impairment doesn’t satisfactorily explain their level of visual function. So, there’s not enough impairment for the degree of lack of visual attention that they might have, and then the third criteria is those, that presence of those ten characteristics. Now it, you know, the diagnosis of CVI in some cases is really straightforward and easy for parents and caregivers to get , in other cases it can be harder, it can be more of a search, and so, you know, what we look for with kids where we suspect they have CVI is we might still say “Let’s do the CVI range” and let’s see how that comes out because the information that we gather there about how they’re using their vision in these accommodated activities can really support, um, taking that to a medical professional and saying “This is something that I’m concerned about, let’s look at it more…”. And so we see a lot of times where a TVI might do a range assessment and then that helps inform the final diagnosis. So what we’re looking for, you know, if you are working with a child, we’re looking for things like strong attention to light, um, only preferring very specific, very familiar objects that the child uses over and over again. Uh, difficulty with visual processing in really noisy, busy environments, or very crowded environments. Um, difficulty with visual motor tasks like reaching accurately for things that are there; so there’s characteristics like this that can really help raise the flags that an assessment is warranted and further conversations with those doctors are warranted as well.

Jared Kittleson: Excellent, excellent stuff Johnathan, thank you for sharing today. Thank you, Johnathan, for the time, we certainly appreciate it, hopefully this is the first of many Teaching Tips Tuesday, uh, you join us on.

Jonathan Graves: I would love it, thank you so much for having me, and, uh, it’s great to see you again.

Jared Kittleson: Thank you everyone for joining us, if you guys have a Teaching Tips Tuesday you’d like to share, please let us know, share it with your friends, and we’ll see you next time.