Introduction

Cortical visual impairment (CVI) is distinctly different from ocular forms of visual impairment. CVI occurs when there is damage to the visual processing areas and/or visual pathways of the brain; this can occur as a result of congenital or acquired conditions. CVI is identified when a child's eye exam cannot explain an observed significant visual impairment, when the child has a history of some neurological damage or cause associated with CVI, and when the specific visual and behavioral characteristics are present. Jan, Groenveld, Dutton, and others have identified these characteristics as attraction to color, visual field differences, atypical attraction to movement, atypical visual reflexes, difficulties with visual novelty, light gazing behaviors, difficulties with distance viewing, visual latency, visual motor difference, and difficulties with visual complexity.

Students who have CVI typically have challenges identifying common objects, images, or symbols when they are presented against a visually complex background (Roman Lantzy, 2007; Jan, 2001). Systematic approaches to assist students increase skills in locating or identifying targets that are part of an array can facilitate improved ability in visual complexity function (Roman Lantzy, 2007). In the beginning, the student uses 3-dimensional objects and as the student's CVI status and thus functional vision improves, the use of 2-dimensional materials may become appropriate.

APH's CVI Complexity Sequences is a product that can be used with students who have CVI and who have had success using 2-dimensional materials. CVI Sequences are intended to help students with CVI locate a target in the presence of increasing amounts of background information. These cards may be used individually or as a sequence and should be presented against a black or plain, light-absorbing background.

Prerequisites

Use CVI Complexity Sequences with students who

• may have a diagnosis of CVI and demonstrate the unique visual and behavioral characteristics associated with CVI.
• demonstrate difficulties with visual complexity.
• are able to discriminate, recognize, or identify common objects in 2-dimensional materials when there is only one image on the page.
• are visually attentive to objects or images that have strong color elements or may have a "preferred" color.

Goals

CVI Complexity Sequences is designed to assist individuals who have CVI improve ability to

• recognize or identify simple, colored, 2-dimensional images presented in isolation.
• recognize or identify images presented with increasing numbers of background elements.
• identify a key image based on the salient features of that image.
• recognize or identify images presented in a variety of locations and with increasing numbers of background elements.

Contents

Ten target-image picture sets:

• yellow dog
• purple sport shoe
• orange basketball
• blue spoon
• yellow flower
• red apple
• brown teddy bear
• pink crayon
• yellow duck
• red toothbrush

Each picture set contains eight cards

• one large, single-object target image
• one single-object target image the exact size as the object image on the cards with increasing levels of complexity
• six additional complexity cards that show the target image and additional images of objects that are typically found in the setting presented on the card

Procedures

1. Present the large, single-object target image card and ask the student to either recognize ("show me the dog") or identify ("name this" or, "what is this?") the image. Describe or discuss the critical, salient features of the target object. For example, the salient features of the duck include a yellow body, an orange beak, and two blue circle shapes that are the duck's eyes. If the student is successful, proceed to #2.

Picture of a white card with a large yellow duck with an orange beak and blue eyes.

2. Present the next single-object target image card which is the exact same image, but smaller. Again, ask the student to recognize or identify the image and the salient features. If the student is successful, proceed to #3.

Picture of a white card with a large yellow duck with an orange beak and blue eyes.

Picture of a white card with a small yellow duck with an orange beak and blue eyes.

3. Ask the student to locate the target image on the next six complexity cards. Use the descriptors of the salient features if the student has difficulty. For example, "Let's try to find the duck in the bathroom by looking for a yellow duck that has an orange beak." Describe more salient features as necessary. Proceed to cards with increasing complexity only when the student is successful with cards that contain lower levels of complexity.

Picture of a white card with a small yellow duck in front of a gray bathtub with a white faucet and an open blue shower curtain.	Picture of a white card with a small yellow duck on a green bathmat in front of a gray bathtub with a yellow faucet, open blue shower curtain, and a yellow shower curtain liner pulled to the right.
Picture of a white card with a small yellow duck and a yellow sponge on a green bathmat in front of a gray bathtub with a yellow faucet, open blue shower curtain, and a yellow shower curtain liner pulled to the right.	Picture of a white card with a green bathmat with a yellow sponge, orange soap, and red towel on it in front of a gray bathtub filled with blue bubbles with a yellow faucet, open blue shower curtain, and a yellow shower curtain liner pulled to the right. A small yellow duck, a pair of blue and yellow thongs, and a purple and blue bathroom scale are located in front of the green bathmat.
Picture of a white card with a green bathmat with a brown dog, orange soap, pink and blue shampoo bottles, and a basket of rolled up towels on it. The green bath mat is in front of a gray bathtub filled with blue bubbles with a yellow duck and toy sailboat in it, and with a yellow faucet, open blue shower curtain, and a yellow shower curtain liner pulled to the right. In front of the green bathmat are a purple and blue bathroom scale, yellow sponge, a blue and tan hairbrush, red towel and a pair of blue and yellow thongs.	Picture of a white card with a green bathmat with a brown dog, orange soap, pink and blue shampoo bottles, basket of rolled up towels, yellow duck, blue and tan hairbrush, and stack of four towels on it. The green bath mat is in front of a gray bathtub filled with blue bubbles with a toy sailboat and pump soap dispenser in it, and with a yellow faucet, open blue shower curtain, and a yellow shower curtain liner pulled to the right. In front of the green bathmat are a pair of gray slippers, a purple and blue bathroom scale, a pair of blue and yellow thongs, a red towel, and a pale yellow oval sponge.

4. Additional cards will present elements that will serve as types of "distracters." These distracters are included in order to require the student to visually inspect the details more carefully. For example, in the red toothbrush series, the toothbrush is in the presence of a red hairbrush and on a different card, it is near a red wastebasket. If the student tends to identify any red object as the toothbrush, it will be necessary to provide instruction regarding the visual features of a toothbrush. It may also be helpful to incorporate both 2- and 3-dimensional examples of various types and colors of the target object.

Picture of a white card showing a pale green wall of a bathroom with one window in it; a leafy tree with a yellow bird's nest containing two red birds is visible through the window. The wall has a yellow board with three hooks; an orange and a pink towel hang on two of the hooks. The white pedestal sink has a gray faucet, and a red cup and a pump soap dispenser are on the sink. A red trashcan with white paper in it is standing next to the sink. A stack of four towels and a pair of gray slippers are to the left of the sink. A tan bathmat is in front of the sink, and a blue bathroom scale, yellow sponge, red toothbrush, and red and blue hairbrush are laying on the bathmat.

5. If the student finds it difficult to locate the target object when it is presented in the more complex cards, the use of a window-card may be helpful. A window card can be made from a piece of heavy, black paper or cardstock. The "window" is an opening that is positioned so that only the target image and small amounts of background detail appear. The non-window portion of the black paper will block all other elements. If the student can identify the target element only when the window card is being used, it is likely that the CVI Sequence card is too visually complex.

CVI Complexity Sequences

Implications for literacy and suggestions for generalization

• As the student is better able to recognize or identify images against complex backgrounds, the student can utilize non-adapted picture books, worksheets, symbol systems, or communication devices.
• Help the student generalize the concepts presented in CVI Complexity Sequences by asking them to locate objects in the 3-dimensional environment, first against simple backgrounds and then in arrays that increase in complexity or numbers of additional objects.
• Describe the salient features of people, objects, and symbols through the use of comparative language. Describe and discuss how people, objects, symbols, or even events are like each other, or how they share traits and how they differ.
• Communication devices, workbooks, and classroom assignments can have multiple images and be visually complex. If a student with CVI has difficulty with CVI Complexity Sequences cards, it is likely that the other classroom materials will also need to be adapted to match the student's visual complexity abilities.

References

Colenbrander, A. (2009). The functional classification of brain damage-related vision loss. Journal of Visual Impairment and Blindness, 103, 118-123.

Dutton, G.N., McKillop. E.C., & Saidkasimova, S. (2006). Visual problems as a result of a brain damage in children. British Journal of Ophthalmology, 90, 932-933.

Good, W. V., Jan, J.E., Burden, S. K., Skoczenski, A., & Candy, R.(2001). Recent advances in cortical visual impairment. Developmental Medicine and Child Neurology, 43 (1), 56-60.

Groenveld, M. (1993). Visual behaviors and adaptations associated with cortical visual impairment. Journal of Visual Impairment and Blindness, 87(3), 101-103.

Jan, J. E., Groenveld, M., Sykanda, A. M., & Hoyt, C. S. (1987). Behavioural characteristics of children with permanent cortical visual impairment. Developmental Medicine and Child Neurology, 29, 571-576.

Roman Lantzy, C.A. (2007). Cortical Visual Impairment: An Approach to Assessment and Intervention. New York, NY: AFB Press.

Whiting, S., Jan, J.E., Wong, P. K., Flodmark, O., Farrell, K., & McCormick, A. Q. (1985). Permanent cortical visual impairment in children. Developmental Medicine and Child Neurology, 27, 730-739.

Notes

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