Cortical Visual Impairment and other Eye Conditions in Children with Multiple Disabilities

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Cortical Visual Impairment and other Eye
Conditions in Children with Multiple Disabilities

• By
• Chris Marshall
• Education Consultant for Visual Impairment
• REACH

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Content

• Eye conditions common in children with multiple
  impairments
• The visual system, how it works - WOW
• What is CVI
• Assessment
• Multi sensory learning
• Assistive technology for MDVI
• Team approach

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Multiple disabilities with a visual impairment.
Associated Eye Conditions

• Cerebral Palsy Hyperopia / Myopia, Esotropia,
  nystagmus,
• Down syndrome Hyperopia / Myopia
• Other conditions include Optic nerve atrophy,
  cataract, microphthalmos, colobomas, ROP,
• CVI or Cortical Visual Impairment

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The Visual System How it works. Just think
about it

• The lens in the front of the eye focuses the
  light
• An upside down and back to front picture is
  formed on the retina
• The retina is made up of millions of cells called
  rods and cones the cones for detecting light
  and color and the rods for seeing in the dark.

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• Light is converted into electrical impulses
• The electrical signal is split into two systems
  motion and detail
• Information runs through fine threads to optic
  nerve
• The two nerves combine together then cross in
  such a way as the picture seen on right side by
  both eyes is processed by left brain WOW

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What is CVI In simple terms

• Some estimates suggest that up to 60 of the
  brain is devoted to vision
• CVI is a neurological disorder
• It results in an inefficient visual sense caused
  by widespread brain disturbance
• Every child with CVI is different

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The seeing brain

• Damage to Dorsal stream make it difficult to get
  around - use Stairs step onto sidewalks reach
  forward and grab a drink
• Damage to Ventral stream makes it difficult to
  recognize faces, objects and places

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CVI Characteristics

• Effects vary depending on which part of the
  vision brain is damaged.
• Reduced visual acuity poor fixation and ability
  to follow and maintain gaze
• Ocular health may be normal
• Stabismus and refractive error common
• May light gaze or be photophobic

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Assessment tools

• In order to support a student we need to gather
  information on what they can see
• The Christine Roman assessment is a good tool
  looks at specific characteristics
• Other methods include interviews with parents,
  teachers and staff - observations and more
  formal tests

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The Ten Christine Roman Characteristics

• Color preference
• Need for movement
• Visual latency
• Visual field preferences
• Difficulties with visual complexity
• Light-gazing / non purposeful gaze
• Difficulty with distance viewing
• Atypical visual reflexes
• Difficulty with visual novelty
• Absence of visually guided reach

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Multi Sensory Learning

• 75 of all learning comes from the visual sense.
  Many VI children have delayed speech and mobility
• To help with sensory integration combine hearing,
  taste, smell, touch and movement such as
  vestibular and proprioceptive senses.
• Consider use of objects of reference sound cues
  and object calendars

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Practical Ideas

• Tac Pac
• Light box
• Sensory studio
• Visual stimulation
• Fluorescent materials and black light
• Drama games
• Body awareness
• Digital camera
• Computer work
• Music

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Sensory room / Light box

• A sensory room is a great resource to develop
  visual response and to work on individual goals
  such as tracking, fixation, color as well as body
  awareness, language and cause and effect

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The Light Box Kit

• Comes in three levels with materials and a
  complete teacher guide
• Can be used to develop individual programs

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Low tech and simple

• Routines are great especially with
  participation for the student
• Get down to eye level and close
• Consider the environment and positioning
• Use songs and music for fun and to help with
  transitions
• Use your name and the name of the child

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Orientation and Mobility

• Remember to make contact with child in wheelchair
  and let them know where they are going!!!

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• Point out landmarks and sensory cues along way
• Use directional language
• Make trip purposeful job or reward at
  destination

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Water and textures
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Experiencing sand or other materials
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Assistive Technology

• AT is a tool that can deliver instructional
  solutions and enhance a students active
  participation in tasks and activities
• AT can include switches, Augmentative
  communication, mounting devices, power link
  switch box, battery interrupters, computer
  software, touch screens

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Adapted Computer

• Black boarder around screen
• Intellikeys with tactile overlay
• Music as a motivator
• Touch screen
• Speech recognition
• Screen readers and magnification

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Collaboration

• Learning team to include parents, class teacher,
  vision teacher, OT, speech, O M specialist,
  physical therapist and TAs
• Multi disciplinary assessment evaluation of
  childs strengths and disabilities
• Develop a meaningful and effective program
• Looking at the whole child to include social and
  emotional development

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Useful Websites

• http//www.pisp.ca/
• http//www.vision.alberta.ca/
• http//www.viscotland.org.uk/
• http//www.prcvi.org/
• http//www.setbc.org/
• http//www.northerngrid.org/ngflwebsite/sen/Menu-L
  .htm