2020 Spring Webinar -- Intervention for Children with CVI -- presented by Dr. Sandra Newcomb for Connections Beyond Sight and Sound

1. INTERVENTION
FOR CHILDREN
WITH CVI
General strategies
Dr. Sandy Newcomb
snewcomb104@gmail.com

2. The CVI Range*
Assessment gives “0” to “10” score
0 = no functional vision
10 = typical visual functioning
Score and Phase
Phase 1 0 to 3 score
Phase 2 3 to 7 score
Phase 3 7 to 10 score
*Roman-Lantzy,C. (2018) CorticalVisual Impairment:An Approach to
Assessment and Intervention, 2nd Ed. APH Press, Louisville, KY.

3. Phases
Phase 1 : building stable visual function
Phase 2: integrating vision with function
Phase 3: visual curiosity, using vision for
learning

4. Build StableVisual
Functioning

5. Phase I
■ High level of environmental control
■ Plan times of the day when the child can
practice vision without other demands
■ For each position that child spends time,
place something (from “vision” toys) to look
at

6. Phase I
■ Use “down” time for vision activities, e.g.
tube feeding
■ Create a box of toys “things Eric will look
at”
■ Use single colored objects/favorite toys

7. Phase I
■ Use characteristics of familiar objects to
introduce new objects
■ Bring items closer and place them on plain
black background
■ Allow child to focus visually without
auditory distraction
■ Present objects in the child’s preferred visual
field

8. Phase I
■ Move object slightly/use reflective
materials
■ Use light to initiate looking at an
object/target
■ Place objects where child can look and/or
touch

9. Sample Phase I materials
■ Lava lamp
■ Rope lights
■ Lighted object by crib/bed
■ Mylar balloon
■ Frame for suspending toys
■ Pegboard stand for toys
■ Wind sock
■ Tri-fold boards to block out background

10. Integrate vision into all
routines

11. Phase 2
■ Integrate looking into each routine
■ Intervention is overlay in all activities
■ Plan the vision component of the
beginning, middle, and end of all
routines

12. Phase II
■ Use objects from Phase 1 with expectation
that child will act on materials
■ Functional materials (toothbrush, cup)
child’s favorite color
■ Mylar or shiny materials on switches

13. Phase II
■ Limit number of objects presented
simultaneously
■ Use lightbox to direct visual attention
■ Move highly motivating objects further away

14. Visual curiosity, using vision
for learning

15. Phase III
■ Development of visual curiosity
■ Spontaneous use of vision
■ Can now look at self in mirror
■ Can now look at and understand pictures

16. Phase III
■ Still may have problems in new
environments
■ Remember prior preferences in color,
movement, light, etc when introducing
novel materials
■ Highlight words with color

17. Phase III
■ Use color as an “anchor” for visual
understanding
■ Highlight picture communication symbols
■ Give visual cue paired with auditory cue
before any action/activity

18. Phase III
■ Preview environments, teach landmarks
■ Tell the student what to look for in a visual
display or environment
■ If child does not look at something, review
complexity

19. Phase III
■ Use movement for distance viewing and
scanning choices
■ Use templates to reduce complexity in 2-
dimensional arrays
■ Point out/teach salient features in objects
and pictures

20. Phase II
■ Touch may initiate looking
■ Use familiar objects in daily routines
■ Shine light on object
■ Introduce photos of favorite objects, first on back-lit
surfaces
■ First books

21. General intervention
principles
■ Intervention must be intentional
■ Intervention must be precise
■ Expect change
■ Always be aware of the environment

22. General intervention
strategies
■ Intervention needs to occur in the context of every day life of
the child
■ Children often perform better at home
■ Provide input at the child’s level, NOT above
■ CVI intervention is an approach not a therapy

23. INTERVENTION
FOR CHILDREN
WITH CVI
By characteristic and phase

24. Color
■ Use favorite color
■ Use consistency in color
■ Ask parent about what
color child responds to
■ Students may ignore
black and white
■ Use color anchor when
teaching difficult
concepts
■ Make a box of “things
to look at” in the
child’s favorite color
■ Use favorite color for
functional materials
(cup, spoon, etc.)
■ For children at higher
level, use color as a way
to let child know what
to attend to

27. A A H A A A A A A A A A
A A A A A A A A A H A A
A A A H A A A A A A A
A A A A A A A H A A A

28. A A A A A A A A A A A
A A A A A A A A A H A
A A A H A A A A H A A
A A A A A A A H A A A

29. Movement
■ May detect movement with peripheral and turn to look with central
vision
■ Reflective objects have movement quality
■ Mirrors are reflective, but watch complexity
■ Use things that naturally move (windsock, balloons, etc.)
■ Use pat-mats
■ Move toy slightly to get child’s attention
■ Use movement to encourage distance viewing

31. Visual novelty
■ Use characteristics of familiar objects to introduce novel
objects
■ Use familiar objects in a “warm-up session”
■ Present important materials consistently and frequently
■ Highlight novel with familiar color
■ Redundancy is not boring for child with CVI
■ Limit novelty

32. Latency
■ Wait, WAIT, WAIT
■ Latency will vary across session
■ Latency will vary based on novelty, fields, color, etc.
■ Fatigue, time of day, illness, etc. also affect latency
■ Positioning also affects latency
■ Always consider latency if looking is not automatic for the child

34. Light gazing
■ Use light as a motivator
■ Use lightbox with children attracted to light
■ Use back-lit tablet (iPad)
■ Be careful about multisensory aspect of lighted toys
■ Position away from light source
■ Watch for windows, overhead lights, ceiling fans
■ Shine light on toy you want child to attend to

38. Field preferences
■ Present objects in preferred fields
■ Present choices in child’s preferred fields
■ Position child in group activity so preferred field is towards
teacher and peers

39. Complexity
■ Use plain non-reflective background
■ Watch for what is on the wall behind teacher
■ Watch for what you are wearing, use smock or apron
■ Use tri-fold board to simplify parts of a room
■ Use single color objects
■ Limit multisensory toys
■ Watch for noise in background

40. Complexity con’t.
■ Use more supportive positions for complex vision work
■ Greet child and then be quiet to give time to look. Remember
that faces are very complex
■ Cover trays with black cloth (pillow case)
■ Reduce complexity of vision work when working on more
complex cognitive or communication goals

41. Complexity con’t.
■ Do not have too many toys out at one time
■ Use child’s verbal skills to help direct where to focus visual
attention
■ Use simple pictures, one per page, plain background
■ Describe salient features of objects
■ Reduce the amount of written information on a page

42. Complexity con’t.
■ Large print reduces complexity
■ Keep work space uncluttered
■ Hand over hand prompting increases complexity
■ Mirrors also reflect what is behind them which increases
complexity

49. Can you find ?

52. Distance viewing
■ Distance is a function of complexity
■ Distance viewing usually begins with large moving targets (a
person walking)
■ Use movement, favorite color, favorite toy, etc. to improve
distance viewing
■ Preview environments and teach child what she is looking at

55. Visual Motor
■ Child may look and look away and reach
■ Position objects so child can act on them
■ Use objects that move when child accidentally touches
■ Use Mylar balloon attached to child’s arm
■ Child may reach for familiar

57. CVI Progression
■ How do we get from here to there???