Cerebral Vision Impairment and the Secondary Student

1. Cerebral Vision Impairment and the Secondary Student A brief overview Alys Stets West Virginia University: SPED 604 Fall 2011 Semester

2. What is Cerebral Vision Impairment? • Commonly referred to as CVI • North America uses “cortical vision impairment” terminology • “cerebral vision impairment” terminology used in Europe • “Impaired vision due to disorders in the optic radiations and/or visual cortex of the brain, to differentiate it from ocular visual impairment, caused by ocular problems” (Colenbrander, 2010). • “CVI is defined as a bilateral loss of central visual function (visual acuity) caused by neurological damage to the visual cortex and ⁄ or visual pathway structures” (Ferziger, Nemet, Brezner, Feldman, Galili, & Zivotofsky, 2011). • In other words: “Essentially, the eyes are capable of takinga clear picture of the environment, but the brain hastrouble interpreting this picture” (Jackel, Wilson & Hartmann, 2010).

3. Characteristics of CVI: • The following information is derived from: • American Printing House for the Blind Website • Normal or minimally abnormal eye exam • Visually attends in near space only • Non-purposeful gaze/light gazing behaviors • Visual latency • Attraction to movement • Atypical visual motor behaviors • Difficulties with visual complexity and crowding

4. Etiology: • Some etiologies of CVI include: • perinatal hypoxic ischemic encephalopathy • postnatal anoxia • periventricular leukomalacia • Infection • asphyxia • brain maldevelopment • cerebral haemorrhage • cardiac arrest • shunt malfunction • hypoglycaemia • uraemia • dehydration • meningitis • encephalitis • intra-uterine infections • head injury • epilepsy • cerebral tumour • Many individuals with CVI have other impairments including: • Cerebral Palsy • Hearing Impairment • Intellectual Disability • Hydrocephalus • Microcephaly

5. Educational Implications: • Students with CVI frequently have “uneven cognitive profiles, often with higher scores on verbal than on arithmetical and visual spatial subscales” (Ek, Fellenius, & Jacobson 2003). • May have delayed visual-motor skills • Tasks need to be repetitive • Consistency of materials across settings • Require multisensory approach to learning • Need real-world materials that will be encountered in every day life • Require extended response and processing time • Supports from teachers of the visually impaired, including orientation and mobility • Vision supports across all settings of home, school, and community • Interestingly, Carolyn Palmer, Associate Dean of Flinders University, states that “because of the visual complexity of regular classroom settings, full inclusion is not advisable as it may reduce the opportunity for meaningful visual perception. Partial inclusion, however, is important for the social and emotional development of the student” (Palmer).

6. Intervention Strategies • Include motion objects whenever possible • High colored objects • Exposure to a variety of literacy modes • Braille • Large print • Text-to-speech • Books on tape/cd • Uncluttered work areas • Lighting accommodations • Orientation and mobility training • Long cane • Sighted guide • Guide dog

7. Intervention Strategies continued… • Preferential seating • Assistive technology supports • Slant board • Switches • Switch adapted equipment • Light boxes • Screen enlargers • Sensory integration • Tactile boundaries • Direct support from a Teacher of the Visually Impaired • Closed Circuit Television (CCTV)

8. Employment • Essential component in Transition planning • Employment with Blindness or Vision Loss • Legislation: American’s with Disabilities Act • Reasonable accommodations • The Job Accommodation Network (JAN) • free service • provides: • Ideas for jobsite accommodations • Legal assistance • Offering self employment options

9. Example of Vocational Adaptation: • Recycling bins: • Reduced complexity using black covers. Yellow stripes used to identify where items are inserted. Bins labeled with the objects • Source: http://www.aph.org/cvi/env_2.html

10. Recreation and Leisure • Important component in Transition planning • Recreation and Leisure Adaptations • Includes: • Crafting • Games • Gardening • Sports • Exercise

11. Independent Living • Critical component in Transition planning • Personal Self-Care Adaptations If You are Blind or Have Low Vision • Includes: • Clothing • Laundry • Makeup • Nail care • Oral hygiene • Shaving • Financial management • Using the telephone

12. Environmental accommodation examples: • Schedule board • Present symbols on black background and incorporate the color red • Source: http://www.aph.org/cvi/env_2.html • Bathroom adaptations • Cover mirror to reduce crowing/complexity • Red and/or yellow tags used to draw attention to critical objects • Source: http://www.aph.org/cvi/env_2.html

13. Frequently Asked Questions • Where can I get help and resources for assisting students with cerebral vision impairment transition to the adult world? Find State and Local Vision Rehabilitation Services • My student has CVI. What considerations does the IEP team need to make? What questions should we be asking? Cerebral Vision Impairment and the Secondary IEP handout

14. References: • American Foundation for the Blind. (2011). Employment with blindness or vision loss. Retrieved from http://www.visionaware.org/employment-blind-low-visionAmerican • Foundation for the Blind. (2011). Personal self-care adaptations if you are blind or have low vision. Retrieved from http://www.visionaware.org/personal-self-care-blind-vision-loss • American Foundation for the Blind. (2011). Recreation & leisure activities adapted for vision impairment. Retrieved from http://www.visionaware.org/recreation-leisure-blind-low-vision • American Foundation for the Blind. (2011). What does 'reasonable accommodation' mean?. Retrieved from http://www.visionaware.org/reasonable-accomodation • American Foundation for the Blind. (2011). Find state and local vision rehabilitation services. Retrieved from http://www.visionaware.org/find_vision_rehabilitation_vision_services_in_your_state

15. References continued: • American Printing House for the Blind, Inc. (2011, April 28). Intervention strategies. Retrieved from http://www.aph.org/cvi/inter.html • American Printing House for the Blind, Inc. (2011, April 28). What is cvi?. Retrieved from http://www.aph.org/cvi/define.html • Colenbrande, A. (2010). What's in a Name? Appropriate Terminology for CVI. Journal Of Visual Impairment & Blindness, 104(10), 583-585. • Ek, U., Fellenius, K., & Jacobson, L. (2003). Reading Acquisition, Cognitive and Visual Development, and Self-esteem in Four Children with Cerebral Visual Impairment. Journal Of Visual Impairment & Blindness, 97(12), 741-754. • Ferziger, N. B., Nemet, P., Brezner, A., Feldman, R., Galili, G., & Zivotofsky, A. Z. (2011). Visual assessment in children with cerebral palsy: implementation of a functional questionnaire. Developmental Medicine & Child Neurology, 53(5), 422-428. doi:10.1111/j.1469-8749.2010.03905.x • Jackel, B., Wilson, M., & Hartmann, E. (2010). A Survey of Parents of Children with Cortical or Cerebral Visual Impairment. Journal Of Visual Impairment & Blindness, 104(10), 613-623. • Palmer, C. (n.d.). Children with cortical vision impairment: Implications for education. Retrieved from www.faculty.sfasu.edu/munromicha/spe516/cvi_palmer_info.doc