The document outlines intervention strategies for children with Cortical Visual Impairment (CVI) across three phases: building stable visual function, integrating vision with daily routines, and fostering visual curiosity. It emphasizes the importance of environmental control, the use of colors and familiar objects, and structured visual activities to enhance visual functioning. General principles include the need for intentional and precise intervention tailored to the child's everyday life and preferences.

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???