Families and Caregivers

At Home: Everyday CVI Adaptations and Approaches

Incorporating opportunities for your child to meaningfully use their vision throughout their day—in daily routines and out in the community—will help improve functional vision. The more a child with CVI establishes and maintains visual attention, the more opportunities to build neural pathways.

"The purpose of interventions designed for individuals with CVI is to provide access to the environment [and] to visual materials. Only through the use of modified visual experiences will these individuals learn to visually interpret their world. Meaningful, rewarding visual opportunities must be provided in order for the brain to be able to take advantage of exposure to visual information. ... Visual experiences must be adjusted and framed in order to enhance not only functional vision, but also cognition, language, social learning, and the ability to sustain movement in the environment." ¹

Christine Roman-Lantzy, PhD

Always think about how vision precedes action. Prompt your child to look at an object before you hand it to them or before they reach for it. This object may be of a preferred color or have something shiny attached (color and movement CVI characteristics). The object may be something that is part of their daily routine. For example, ask your child to find a pull-up on their bed before getting changed, the carrots on their plate, a book before reading time, pants to put in the laundry basket, and so on. Instead of saying "look," ask "Where's the...." or "Show me the...", for example. When placing an object or picture in your child’s preferred visual field, ask “What do you see?” This will help you understand how your child interprets visual information. And the use of salient feature instruction is critical in helping your child with CVI discriminate details of an object or picture, which will in turn help build their visual map of the world around them.

Become a radio parent, narrating what you see and hear in an environment to help your child with CVI orient, organize, and understand what is going on around them. Use anticipatory language to help your child understand what's happening next or the daily the schedule. The visual world is rich with anticipatory cues, but our kids miss these cues entirely and often become anxious about transitions and changes. Preview a routine, schedule, or new environment using objects or pictures and descriptive language.

Below are examples of how parents incorporated adaptations and approaches based on the 10 CVI characteristics (Roman-Lantzy, 2007, 2018).

Example of meal time for child in Phase I

Intentional use of light on spoon to prompt use of vision while eating.

Example of meal time for a child in late Phase II

Use of preferred color (red) for utensils and bubble words on AAC device, slant board to accommodate preferred visual field, and reduced complexity of background.

Play time for child in Phase I

Use of preferred color, shiny items (has movement properties), reduced complexity of background and objects, and familiar items (reduced novelty).

Household routines for child in Phase II

Preferred color (yellow) shoe bin and around cubby to prompt vision and promote independence; Roman word bubbling "shoe."

Math concepts for child in Phase II

Light box with overlay to support 1:1 counting, reduced complexity of array and environment, Roman bubbling of words.

PT/OT practice for child in Phase II

To support visual motor: reduced complexity background and vibrant colored items placed is preferred visual field.

Play time for child in Phase II

Reduced complexity photograph of favorite toy presented on an iPad (light) to support transition from 3D to 2D.

Reading for child in Phase III

Adapted book on a iPad (light), with reduced complexity images and array.

Sight word practice for child in Phase II

Household item labeled using the Roman word bubbling approach, use of red outline to highlight shape and salient features of word.

Bathroom routine

Use of preferred color to support vision use during brushing teeth and hand washing; reduced visual clutter.

"The strategies used for improving vision should be integrated into daily, functional activities of learning, self-help, leisure activities, and so on. Isolated, meaningless activities, such as asking a child to gaze into a flashlight, do not easily translate into meaningful function." ²