Texas School for the Blind and Visually Impaired Outreach Programs www.tsbvi.edu | 512-454-8631| 1100 W. 45th St. | Austin, TX 78756
Cortical Visual Impairment (CVI 101) Beat the Heat ESC 13 June 25th, 2015 2:15-3:45
Presented by Sara Kitchen VI Education Specialist
[email protected] Developed for Beat the Heat, ESC 13, 2015
Cortical/Cerebral Visual Impairment (CVI 101) Overview • • • • •
What is it? How do we think about it? What does it look like? Assessment Intervention
What is CVI? Definition • “Congenital or acquired brain-based visual impairment with onset in childhood, unexplained by an ocular disorder, and associated with unique visual and behavioral characteristics.” (The multidisciplinary definition of pediatric cortical visual impairment according to The Second American Conference on Pediatric Cortical Visual Impairment2013) (http://www.childrensfoundationomaha.org/documents/Continuing%20Medical%20Educat ion/Legge-PCVI%20past%20present%20future%202014.pdf) • Primary cause of visual impairment in so-called first world countries in which advanced medical interventions are available to infants in children. (Page 9, Cortical Visual Impairment: An Approach to Assessment and Intervention, Roman-Lantzy, ©2007, AFB Press.) RED FLAGS Congenital • • • • • • •
Asphyxia and Perinatal Hypoxic-Ischemic Encephalopathy (HIE) Intraventricular Hemorrhage (IVH) Periventricular Leukomalacia (PVL) Cerebral Vascular Accident/Cerebral Artery Infarction Infection Structural Abnormalities Metabolic Conditions
Acquired • • • • • • • •
Asphyxia Blows Gunshot wounds Car accident Shaken baby syndrome Infection Tumors Optic radiation damage (MS, etc.)
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How many of our students have CVI? • • • • •
2015 VI registration for Texas: 15% of children with VI have CVI listed as their primary etiology. Add in VI caused by “red flags”: 20% have CVI ROP: 12% ONH/SOD: 7%
How do we think about CVI? Ocular vs. neurological impairment. Over 40% of the brain is involved in visual processing (Page xvii, Vision and the Brain: Understanding Cerebral Visual Impairment in Children, Lueck, Duddon,© 2015, AFB Press) Neuroplasticity (Merzenech, 2008) https://www.youtube.com/watch?v=UyPrL0cmJRs&list=PL24D9300D6952F1B5 • Most limitations arising from abnormal development, from normal aging, or that lead to or stem from neurological or psychiatric illness are reversible or correctible. • We can improve (at any age) o o o o o o
Fidelity Power Coordination Complexity Noise-Immunity Speed
• At every level (cognitive…etc.), Merzenich(2008)
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What does CVI Look like? • • • •
Total blindness, except… Unusual behavior? Autism? The visual perceptual system and resulting behaviors.
10 Behavioral Characteristics (Roman, 2007) Attraction to: • • •
A particular color or pattern Items that are moving or have movement qualities Lighted items
Unusual visual behavior: • • •
Visual field preference Visual latency Visual reflexes
Difficulty with: •
Complexity of o The visual target o The visual background o The sensory environment
• • •
Visual motor skills Targets at a distance Visual novelty
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Assessment • Cortical Visual Impairment: An Approach to Assessment and Intervention, ©2007 AFB Press, by Christine Roman-Lantzy. • Strategy To See, ©2015 VeriNova LLC, by Diane Sheline. • Vision and the Brain: Understanding Cerebral Visual Impairment in Children, ©2015 AFB Press, by Amanda Hall Lueck & Gordon N. Dutton. • Takes a TEAM and a knowledgeable guide. • Gather information from medical & eye reports, interviews with parents, teachers and therapists and observation of the child in familiar, unfamiliar, bright, dark, noisy and quiet environments. • Directly assess to find the CVI Range/Phase or Level of Functioning Roman-Lantzy’s Resolution Chart and Phases (Assessment Results) • Phase I: Building visual behavior • Phase II: Integrating vision with function • Phase III: Resolution of CVI Characteristics Intervention (Use it or Lose it) Attention & Alertness Motivation Repetition & Practice Slight change “Throughout the process of encouraging a child to look and use their vision, it should always be kept in mind that providing slight change strengthens connections between neurons.” (p. 19 Strategy to See) • Intervention: Task Analysis (more on CVI at http://www.tsbvi.edu/cvi-exercise) • • • •
Local Resources • ESC 13! (Debra Leff) • CVI Study Group (TSBVI Outreach and Diane Sheline http://www.tsbvi.edu/on-the-golearning/webinar-listings) • CVI Clinic (TSBVI Outreach & Diane Sheline & ESC 13 and/or DARS) • Strategy to See (Diane Sheline-strategytosee.com)
Thank YOU! Please fill out your evaluation!
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Texas School for the Blind & Visually Impaired
Outreach Programs
Figure 1 TSBVI logo.
Figure 2 IDEAs that Work logo and OSEP disclaimer.
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Texas School for the Blind & Visually Impaired Outreach Programs www.tsbvi.edu | 512-454-8631 | 1100 W. 45th Street | Austin, TX 78756
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