Educators and Therapists

Teaching and Learning in Phase II CVI1

Published with permission from author, Dr. Christine Roman-Lantzy.

In Phase II CVI, the goal is integrating vision with function. Now that the individual has consistent looking behaviors, he or she can build the ability to visually fixate and cause an action or reaction to an object. This eye-to-object contact represents the strengthening of the ventral stream vision, or the “what” system, which allows an individual to identify details. The development of ventral stream processing will continue to develop in Phase II and into Phase III. (177) The individual now has enough consistent visual behavior to look at objects, reach for a desired object, or use gaze to indicate a want or need. (201)

A word of caution: Do not confuse looking with interpreting. Though a student may fixate on an object, she may not be able to understand what she sees. It is the job of teachers, therapists, and parents to support the looking with appropriate language and comparative thought (i.e., demonstrating the similarities and differences between various objects). (177) 

Complexity will still have a significant impact on a child in Phase II. The individual will increasingly be able to interpret three-dimensional objects with more than one color and one or two simple patterns, though he will show more sustained eye-to-object contact with objects in his preferred color. (187, 201) The individual in Phase II CVI can notice objects at distances as great as four to five feet away (up to 10 or more feet by the end of Phase II). (201) Low levels of background noise will no longer distract a child in Phase II from using his vision, and he will have very little latency. (201) 

Interventions for Phase II CVI 

At this stage, all activities should promote the use of vision to cause action or make an impact. Interventions and adaptations based on the CVI characteristics must be incorporated systematically throughout the child's day in order to provide visual access. Incorporate intervention activities into the child's daily routines—for example, during mealtimes, leisure time activities, self-care routines, academic tasks, fine motor skills practice, gross motor skills practice, speech and language, and O&M routines. (199)  Create activities that require vision to accomplish a task, such as reaching for an item needed in a self-care routine. (187)

Interventions for Phase II CVI students generally require attention to these considerations:

It's important to continue to control and reduce complexity of object, array, and sensory environment. Complexity of the environment and task must be consistently evaluated and address to avoid cumulative visual fatigue. As a student moves through Phase II, he will be able to interpret more patterns on three-dimensional objects. (201) Once a child scores about 5 on the CVI Range, he will begin to discriminate two-dimensional images presented with backlighting and the support of salient features instruction. (187) 

Even though a child in this phase will generally stop staring at lights, backlit devices will motivate attention and reduce fatigue. The iPad or a similar tablet is an essential tool for students with CVI. For example, the iPad offers the necessary accommodations (light, high resolution) to help students in Phase II move from interpreting a 3D object to a 2D photograph of that object with reduced complexity. Backlighting allows the individual to sustain visual attention when engaged in more complex visual tasks. (201)

You may continue to use shiny, reflective materials to bring attention to objects. Shiny or reflective strips can be used to help direct attention to any object used in functional routines—for example, wrapping or enhancing cups, toothbrushes, or switches for switch-operated objects. (202) Movement continues to help the individual attend to an object outside of their preferred visual field or at a distance beyond his comfort level.

Placing objects on plain backgrounds, primarily black, will promote visually guided reach. Make sure there is minimal visual clutter in the child's field of vision to reduce complexity. (While you can make adaptations to promote visually guided reach, this characteristic cannot be directly taught.) (202)

Novel objects may be introduced based on their similarities to known objects, for example, objects that are the same color as a favorite toy. (202) New objects require explanation and instruction in their salient visual features. The use of comparative language allows students with CVI to make sense of what is the same and what is different when comparing a new item to a familiar item.  

Even though visual latency improves when students enter Phase II, they still require additional wait time to process visual material and tasks. Visual latency increases when the student is tired, stressed, or their “CVI battery” is drained.

CVI and the IFSP/IEP

1Roman-Lantzy, C. (2018) Cortical Visual Impairment: An Approach to Assessment and Intervention. 2nd ed. pp. 177-202. New York, NY: AFB Press.

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