CVI Fact Sheet for 
Therapists (PTs, OTs & SLPs)
Cortical Visual Impairment (CVI) is a congenital or acquired brain-based visual impairment which is unexplained 
by an ocular disorder and associated with unique visual and behavioral characteristics. 

A child has CVI when: 

• 
The visual loss cannot be fully explained by an 
eye exam. 
• 
There is a history of a neurological condition or 
traumatic event that affects the brain — even if 
brain imaging studies appear normal. 
• 
The child demonstrates a set of unique visual and 
behavioral characteristics identified in medical 
and educational research. 1, 2 

“Some of these 
characteristics can be 
confused with signs of 
other prevalent diagnoses 
such as autism. 

Similarities include 
watching objects that 
move, trouble making eye 
contact with others, a 
preoccupation with light... 
These are things I keep in 
mind, especially when a 
child has a history of a 
neurological condition. 


Stephanie N. Hall, M.S., OTR L, ITFS 

What are the most common causes of CVI? 

Medical conditions that disrupted a portion of the 
visual pathways can cause CVI. These can include: 


• 
Perinatal hypoxia 
• 
Hydrocephalus 
• 
Traumatic brain injury 
• 
Congenital infections such as cytomegalovirus 
Intraventricular hemorrhage 
• 
Periventricular leukomalacia 
• 
Genetic disorders 
• 
Stroke 
Researchers estimate up to 70% of children with 
cerebral palsy aslo have CVI. 3 


Behaviors commonly associated with CVI: 

• 
Lack of visual curiosity 
• 
Hesitancy interacting in new environments or with new items 
• 
Difficulty looking at and reaching for objects at the same time 
• 
Increased visual attraction to lights, windows, or ceiling fans 
• 
Tendency to respond to sound or an auditory stimulus, rather than to 
visually regard and see a target 
• 
Difficulty finding objects in a busy environment, such as the grocery 
store or playground 
• 
Difficulty navigating through a building or community environment 
• 
Tilts head to regard object in a specific visual field 
• 
May have difficulty with lower field visual regard, affecting navigation 
of stairs, curbs and terrain changes, playground slides, and notice of 
objects on the ground 
• 
Difficulty making eye contact or recognizing familiar faces 
• 
Difficulty visually attending in a busy environment 
• 
May take longer to look at or visually process information 
For more information, visit PCVIS at pcvis.vision 


PCVIS is a 501(c)(3) nonprofit organization transforming outcomes for children with CVI by advocating for research, 
policy, education, practice, heightened awareness and understanding of this brain-based visual impairment. 


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What is the therapist’s role? 

• 
Evaluate the child’s functional skills to determine 
the cause of the underlying impairment(s) such as 
functional vision vs. sensory vs. coordination 
(usually OT). 
• 
Develop a treatment service plan addressing 
functional performance that incorporates 
functional vision and visually guided movement. 
• 
Facilitate social interactions and participation. 
• 
Recommend assistive technologies that support 
use of vision, such as: 
-Mobility aids: walker, gait trainer, wheelchair. 
-Seating: adaptive seating or positioning device. 
-Communication: Augmentative and Alternative 
Communication Devices (AAC). 

• 
Collaborate with caregivers regarding: 
-Environmental adaptations (home, school, and 
community). 
-Adaptations to daily activities and routines. 
-Observations of child’s visual responses before 

and after adaptations. 
-Provide ongoing education and resources 

• 
Collaborate with other professionals regarding: 
-Effective visual adaptations. 
-Child’s functional performance in other 
environments and conditions. 


What can you do if you suspect CVI? 

• 
Refer the individual to an ophthalmologist, 
neurologist, neuro-ophthalmologist, or 
optometrist. 
• 
Communicate with the physician and/or give 
parents specific language to discuss with the 
physician. 
• 
Contact school personnel to ensure the child is 
assessed by all relevant disciplines (i.e., Teacher 
of Students with Visual Impairment and 
Orientation and Mobility Specialist). 
• 
Recommend or perform a functional vision 
assessment specific to CVI (e.g., CVI Range© 
1, 2). 
• 
Trial environmental and task adaptations to 
improve visual response. 
Common task, material object, 
and environmental adaptations 

• 
Reduce the complexity of a visual target/object. 
• 
Reduce or eliminate background information (e.g., 
put up black trifold, reduce clutter). 
• 
Reduce the number of items offered at one time. 
• 
Allow extra time for a child to view an object 
before moving it to a new position. 
• 
Position materials or objects in the child’s best 
regarded visual field. 
• 
Change light as needed by either eliminating 
distracting light and/or using light to spotlight a 
specific object to elicit visual attention. 
• 
Seating away from a busy part of the room 
and/or preferential seating. 
• 
Use one bright color to highlight a specific part of 
materials or environmental features. 
• 
Use language to support vision by labeling the 
salient visual features of an object. 
Things to consider 


• 
Visual accommodations should be considered for 
all aspects of a child’s day. 
• 
Apparent fluctuations in vision manifest from 
changes in environments and internal states. 
• 
Consider how vision is used in a variety of 
situations and environments. 
• 
Consider the impact of vision on the identification 
of any motor delay. 
• 
Incorporate vision strategies from professionals 
who understand the child’s vision. 
• 
The level of visual support needed may change. 
When the child is completing a familiar task, they 
may not need as many adaptations. When the 
child is learning a new task, make it easier to use 
vision by providing additional visual adaptations. 
• 
Look for opportunities to challenge vision when the 
child is highly motivated or familiar with the task 
(e.g., during feeding or during a highly preferred 
task). 
1 Roman-Lantzy, C. (2018). Cortical Visual Impairment: An Approach to Assessment and Intervention. 
2nd ed., New York, NY: AFB Press. 
2 Roman-Lantzy, C. (2019). Cortical Visual Impairment: Advanced Principles. Louisville, KY: APH Press. 
3 Durkin MS, Benedict RE, Christensen D, et al. (2016) Prevalence of Cerebral Palsy among 8-Year-Old Children in 2010 and 
Preliminary Evidence of Trends in Its Relationship to Low Birthweight. Paediatr Perinat Epidemiol. 


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