Educators and Therapists
CVI strategies for educators
CVI strategies for educators are essential for recognizing and responding to the unique learning needs of students with cerebral/cortical visual impairment (CVI). Because CVI affects how the brain processes visual information, traditional teaching methods and vision assessments may overlook a student’s true capabilities. When educators understand the common causes and behaviors associated with CVI, they can identify signs earlier, advocate for accurate assessment, and tailor interventions that support access to the curriculum. By using targeted strategies, teachers, therapists, and TVIs can help students with CVI build meaningful visual skills and achieve their full learning potential.
CVI strategies differ from strategies for ocular visual impairment
Students with CVI have unique visual deficits related to higher-order visual processing pathways in the brain. In other words, students with brain-based visual impairment have trouble not only with seeing but with interpreting what is perceived by the eyes.1
Traditional assessments fail to accurately gauge the ability and understanding possessed by a child with CVI. However, through the use of an intentional, systematic approach and methodology, children with CVI, across varying levels of abilities, can learn to understand the world around them and achieve academically, thrive socially, and acquire independent life skills. The brain has a remarkable ability to change, known as neuroplasticity, and students with CVI may improve their functional vision and access to their visual world over time.2
A TVI stands next to two elementary school students who are using a large abacus with yellow and red beads, often preferred colors for students with CVI.
A TVI sits with two students in an elementary classroom. They are reading books on tablets, which gives them the benefit of backlighting and custom text.
What educators should know about CVI
The criteria doctors use to diagnose CVI
- The child has a neurologic condition affecting the visual pathways in the developing brain.
- There is visual dysfunction that cannot be explained by any ocular abnormality.
- The visual deficits involve visual acuity, contrast sensitivity, and/or higher-order visual processing.
- The visual dysfunction cannot be explained by autism, dyslexia, or another disorder of learning, language, or social communication.
Common causes of CVI
- Perinatal hypoxia
- Hydrocephalus
- Traumatic brain injury
- Congenital infections such as cytomegalovirus
- Intraventricular hemorrhage
- Periventricular leukomalacia
- Genetic disorders
- Stroke
What educators should do if they suspect CVI
- Refer the child to an ophthalmologist, neurologist, neuro-ophthalmologist, or optometrist.
- Communicate with the physician and/or give parents specific language to discuss with the physician.
- Complete the CVI Range©, which includes interview, observation, and direct assessment.3
- Implement intentional goals and interventions based on the CVI Range score.
- Develop a CVI Schedule to allow the child visual access throughout the day.
How behaviors commonly associated with CVI may show up in the classroom:
- Difficulty using eyes and hands together
- Difficulty looking at and reaching for toys
- Difficulty with fine motor and visual motor skills at the same time (look, look-away, reach pattern)
- Overly attracted to lights
- Tendency to respond to sound or an auditory stimulus, rather than to visually regard and see a target
- Difficulty finding objects in a visually complex environment, such as the playground
- Head turns more frequently toward one visual field
- Difficulty making eye contact or recognizing familiar faces
- Delayed or absent blink to touch and threat
- Difficulty finding the way around the school campus
- Lack of visual curiosity
- Novel objects and/or toys may not be regarded
- Difficulty attending to targets (people, objects, classroom board) at far distances
- Requiring the addition of light and/or movement to elicit a visual response to target/object
- Difficulty navigating through a crowded space, for example, a child may freeze and stay in place, hold onto an adult, or move more quickly than is safe
- May have difficulty with lower field visual regard, affecting navigation of stairs, curbs and terrain changes, playground slides, and noticing objects on the ground
- Difficulty recognizing, discriminating, and/or identifying images or objects; confusing targets that are similar to others, for example, labeling four-legged animals as the same animal
Proper assessment leads to appropriate CVI strategies
Understanding the CVI Range© Assessment
The CVI Range is an educational tool to assess the degree of impact on the visual functioning of a child with CVI. Developed by Christine Roman-Lantzy, PhD, specifically for those with CVI, the CVI Range was an outgrowth of the system she used as a TVI/O&M to teach children who had been dismissed as unteachable. Based on information gathered during an interview with parents or caregivers, observation, and direct assessment, the CVI Range evaluates the overall extent to which the visual and behavioral characteristics associated with CVI interfere with the child's use of vision and the degree to which each of the characteristics affects the child.3 (85-92)
Dr. Christine Roman evaluates a child in a highchair by placing small yellow objects on the tray, which is covered with a black mat.
Expectation of Improvement
The term “range” indicates that functional vision of a child with CVI is measured on a continuum, and that the functional vision can be improved with systematic and tailored interventions.3 (83) The scoring system uses a scale of 0 – 10, with 0 recording no detectable functional vision and a score of 10 reflecting functional vision of that of a typical child of the same age.3 (92) A child with CVI would not be able to score a 10, as that would indicate no evidence of CVI.
CVI does not fully resolve. A score of 9 is also extremely rare, and practitioners should be wary of a child with a Range score of 9 or above.
Through the use of an intentional, systematic approach and methodology, the child’s functional vision will begin to develop. As this occurs, the child will move from dorsal stream vision, the “where” system, which relies heavily on movement, form, and light, into the higher functioning central/ventral stream vision, the “what” system, which provides visual recognition.3 (14-15) The development of these streams of vision can be measured through the use of Roman-Lantzy's CVI Range assessment, and scored in one of the three Phases she identifies on the continuum of functional vision development for children with CVI.
The CVI Range allows educators and related service providers the opportunity to draw directly from the scoring statements to identify Present Levels of Performance and guide descriptions of accommodations and adaptations to support visual functioning for a student's Individualized Education Program (IEP) or Individual Family Service Plan (IFSP), if the child is younger than three years old.
Statements in Rating I of the Range with a score of “+” are the child’s Present Levels and can be incorporated into the IEP. For example: Sally is able to demonstrate eye-to-object contact or visual fixation when the environment is controlled for sound and visual clutter.
Scores from Rating II can be used to identify accommodations and adaptations for areas which scored less than a “1.” Visual complexity, visual array (score .25): Jack’s workspace should be free of clutter and he should be facing a gray or black background. Adults should wear either neutral color clothing or place a black work apron over their patterned clothing while working with Jack on activities designed to incorporate use of vision.
Want to learn more about CVI learning strategies and how to better serve your students?
1 Download our CVI Fact Sheet for Teachers of Students with Visual Impairment.
2 Read Cortical Visual Impairment: An Approach to Assessment and Intervention (Roman-Lantzy, 2007, 2018) and Cortical Visual Impairment: Advanced Principles (Roman-Lantzy, 2019).
3 Participate in ongoing professional development in CVI best practices from Perkins School for the Blind's CVI Center, including the CVI Now Educator Hub.
4 Learn more about the “What's the Complexity?” Framework, created by Matt Tietjen.
5 Join PCVIS and attend our Annual Meeting!
The impact of CVI beyond learning academics
CVI affects a child’s ability to engage socially, to interpret the meaning of an object or activity, or identify a place or a person, even his own mother. Without the advantage of incidental learning through visual observation, spoken words may be void of meaning for a child with CVI. For more information on CVI and the development of social skills, read Chapter 5 of Cortical Visual Impairment: Advanced Principles.
Perkins CVI Center
Educational Resources
References
1 Martín, M. B., Santos-Lozano, A., Martín-Hernández, J., López-Miguel, A., Maldonado, M., Baladrón, C., Bauer, C. M., & Merabet, L. B. (2016). Cerebral versus Ocular Visual Impairment: The Impact on Developmental Neuroplasticity. Frontiers in psychology, 7, 1958. https://doi.org/10.3389/fpsyg.2016.01958
2Handa, S., Saffari, S. E., & Borchert, M. (2018). Factors Associated With Lack of Vision Improvement in Children With Cortical Visual Impairment. Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society, 38(4), 429–433. https://doi.org/10.1097/WNO.0000000000000610
3 Roman-Lantzy, C. (2018) Cortical Visual Impairment: An Approach to Assessment and Intervention. 2nd ed. New York, NY: AFB Press.