Transcript Teaching Purposeful Mobility Skills to Students with

Presenter:
Gregory Santamoor, MS, TVI
Content
 Overview of Session and Participant Learner
Objectives
 Introduction to Cortical Visual Impairments (CVI)
 Interventions and Teaching O&M
 O&M Students with CVI in EVS
 Applying strategies based on student needs
 O&M Instructional Approaches
 Integrating Learned Activities
Introduction to CVI →
 Your understanding
 Definition
 Terminology/Diagnoses
 New Developments
 Causes
 Incidence
 Educational Challenges
 Teaching Approaches for children with CVI
Definition 1
“Cortical Visual Impairment is a temporary or
permanent visual impairment caused by the
disturbance of the posterior visual pathways
and/or the occipital lobes of the brain.”
 Ref: www.blindbabies.org
Definition 2
“Cortical Visual Impairment is a neurological disorder,
which results in unique visual responses to people,
educational materials, and to the environment.”
 Ref: www.aph.org
Definition 3
Cortical Visual Impairment refers “to a visual loss caused
by some disturbance to the ‘posterior visual pathway’ or
‘visual cortex’ which encompasses difficulty in
processing and interpreting incoming visual
information.”
 Ref: Teaching Exceptional Children Plus article Volume 4,
Issue 5, May 2008
CVI – AKA…
What Is and Is Not CVI
Is CVI
 Cortical Visual Impairment
 Cerebral Visual Impairment
 Neurological Visual Impairment
Is Not CVI
 Hemianopia –damage to optic nerve/tract
 Absolute Scotoma –specific blind area
 Functional Blindness –possibly psychological
 Visual Agnosia –inability to recognize common object
 Visual Neglect
 Ref: www.aph.org
New Developments
 American Printing House CVI Advisory Group in
2008 and ongoing efforts to recognize CVI as a
separate visual impairment to receive Federal Quota
Funds.
 Creation of CVI website through APH
 Inclusion of CVI through Familyconnect.org (NAPVI)
 CVI included and recognized by NYS Department of
Health as one of the most common visual impairments
According to Dr. Roman-Lantzy…
“Experts do not agree whether cortical
visual impairment, neurological visual
impairment, brain damage-related to
visual impairment or some other term
will ultimately be chosen.”
More from Dr. Roman-Lantzy…
“Cortical visual impairment is more
commonly used in North America,
while cerebral visual impairment is
generally used in Europe.”
Causes 1
 Hypoxia –lack of oxygen to the brain
 Encephalopathy –damage to the brain
 Intra-ventricular hemorrhage
 Peri-ventricular leukomalacia
 Cerebral vascular accident
 Central nervous system infection
 Structural Abnormalities
 Head/brain trauma
Causes 2
 Microcephaly
 Hydrocephaly → Shunt malfunction
→ Intracranial pressure
 Hypoglycemia
 Meningitis
 Epilepsy
 Poisoning/Drug exposure
Related Neurological problems
 Cerebral Palsy
 Seizure disorders
 Cognitive impairment
 Hearing loss
 Memory dysfunction
Incidence
 Cortical visual impairment is considered to be the
PRIMARY cause of visual impairment in First World
countries.
 In the United States the top four (according to the NY
State Department of Health Clinical Practice
Guidelines in Visual Impairment):
 Cortical visual impairment
 Retinopathy of Prematurity
 Optic Nerve Hypoplasia
 Structural Abnormalities
Incidence continued…
The most common cause of visual
impairment in children WORLDWIDE
is ________?__________.
And the answer is…
Ulceration (or scarring) of the
cornea, secondary to Vitamin A
Deficiency.
According to the American Foundation for the Blind,
30-40% of children with a visual impairment have CVI
Educational Challenges
Signs and Symptoms
 Variable visual responses
 Visual Latency –delayed responses
 Use of peripheral vision rather than central vision
 Visual Novelty –prefer more familiar objects over novel
objects
 Visual field restrictions
 Poor Depth Perception
 Absence of visually guided reach
 Better visualizing moving target than motionless
Educational Challenges
Signs and Symptoms continued…
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Figure-Ground Perception
Compulsive Light Gazing/Photophobia
Color preference (color may act as anchor)
Lack of sensory nystagmus vs. presence of motor
nystagmus
 Non-purposeful gaze
 Difficulty with Visual Complexity
 Pattern on surface of an object
 Visual array within surrounding environment
 Complexity of sensory environment
What is it like for a child with CVI?
 Akin to looking through Swiss cheese
 Imagine trying to find one person in a football stadium
while standing on the 50 yard line
 Like looking at modern art
 Similar to looking at an unfinished jigsaw puzzle
 Continuously playing “find the hidden object”
Visual
Pathways
Cross
Section
Damage to Optic Nerve and tract
General Teaching Considerations
 Allow for intermittent breaks
 Child should be positioned comfortably
 Avoid challenging a child with CVI with a visual task
and other fine or gross motor task
 Work in a simple uncluttered visual environment
 Use familiar objects
 Repetition is important
 Use vibrant colors such as red, yellow and orange
Teaching Considerations cont…
 Use toys and materials which are motivating to child
 Pair visual tasks with other sensory systems such as audio
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or tactile (to support visual task)
Use verbal descriptions of materials
Arrange optimal lighting – preferably from behind child
Move the target you want him/her to see
Utilize different visual fields for optimal responses
Allow for additional time
Ref: www.blindbabies.org
Additional Suggestions from
Teaching Exceptional Children Plus
 Use boundaries or borders around target when
possible
 Use technology (changing settings on PC/laptop)
 Recognize that behaviors (i.e. maladaptive) may be a
way child is communicating
 Start sessions at levels child can achieve
 Consider less inclusion – What is the best LRE for the
child?
 Keep team members informed
Role and Approach of O&M Instructor
 Connect and consult with TVI
 Connect and consult with rest of team –including family!!
 If possible, take part in Functional Vision Assessment and
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Learning Media Assessment
Review Functional Vision Assessment, if you do not
participate in the process
Get updated eye report
Agree upon approach and strategy with team members that
is consistent and that meets student’s needs
Be flexible as your approach may need to be changed to
better suit the student
Characteristics of Cortical Visual Impairment Checklist
Children with other types of visual impairments may exhibit some of these
characteristics.
CHILD’S NAME_____________________________ AGE________ DATE______
RESPONDENT’S NAME & RELATION TO
CHILD________________________________
A child may be suspected of having a cortical visual loss when the extent of visual
loss is unexplained by ocular abnormalities. Etiologies may include cerebral
palsy, asphyxia, intracerebral hemorrhage, and meningitis.
Please check any areas below that pertain to the child.
APPEARANCE
___Does not look blind
___Blank facial expression
___Lack of visual communication skills
___Eye movements smooth, but aimless
___Nystagmus (rapid eye movement) rarely seen
VISION FUNCTION
___Visual function varies from day to day or hour to hour
___Limited visual attention and lacks visual curiosity
___Aware of distant objects, but not able to identify
___Spontaneous visual activity has short duration
___Visual learning tiring
___Closes eyes while listening
___Balance improved with eyes closed
___Look away from people and objects
___Consistently look to either side when visual looking
___When visually reaching looks with a slight downward gaze
___Turns head to side when reaching, as if using peripheral fields
___Uses touch to identify objects
MOBILITY SKILLS
___Occasionally "sees" better traveling in a car
___Difficulties with depth perception, inaccurate reach
___Unable to estimate distances
___Difficulties with spatial interpretation
___Avoids obstacles, but unable to use vision for close
work
IMPROVED VISUAL PERFORMANCE
___When in familiar environments and when using familiar
objects
___When told "what" to look for and "where" to look
___When objects are held close to eyes when viewing
___When objects are widely spaced
___When looking at one object verses a group of objects
___When color is used to assist in identification of objects or
shapes
___When objects are against a plain background and paired
with movement and sound
K. Appleby’s compiling information from article by: Jan, J.E., Groenveld, A., Sykanda, A.M.,
Hoyt, C.S. (1987) "Behavioral Characteristics of Children with Permanent Cortical Visual
Impairment." Developmental Medicine & Child Neurology, 25,755-762.
O&M suggestions for children with CVI
The follow suggestions are based on the
Texas School for the Blind presentation
on March 31, 2012 by Lisa Colaci, COMS
and Ruth Ann March, COMS
Color Preference
 Wear student’s favorite color
 Mark key locations with the student’s favorite color
 Consider using AmbuTech red and orange ball and roller
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tips
Use tape in a student’s favorite color to mark the placement
of hands (or the lower bar) on a pre-cane device
Point out red lines on sides of aisles (grocery store)
Direct focus to overhead department store signs also often
in red
Incorporate preferred color in maps for student’s use
Attraction to movement
 Mark key points on route - helium balloons
(favorite color) tied to weight
 Use Mylar pompoms to mark key
destinations
 Use hand motions to direct attention or
provide directional cue
Visual Complexity
 Avoid wearing overly busy clothes
 Expect the student to have difficulty recognizing faces;
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provide verbal prompts in social settings
Provide opportunities to practice recognizing faces by
using photos of key people seen regularly
Spend ample time familiarizing to new classroom/school
prior to beginning of year before teachers begin decorating
Schedule at least one lesson after teachers have returned
Provide ample practice the first few days of the school year
after students return
Visual Complexity cont…
 Try to limit visual complexity when choosing training sites,
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especially when teaching a new skill
Use of telescope, binoculars, digital camera or cell phone
may help control for visual clutter (as well as be a
motivator)
Cane or pre-cane device may help student focus on what is
ahead
Looking at the cane as it moves may help cut down on
visual clutter by decreasing array
Cane movement may attract student, promote use of
vision, but distract from awareness of other key visual
information
Visual and Environmental Complexity
 Because of difficulty attending to more than
one source of sensory input at a time, try to
limit auditory prompts as they tend to
interfere with vision
 Use physical prompts, especially those that
involve movement
Visual Novelty
 Very connected to visual clutter
 Use sequence of photos with increasing complexity to
introduce/familiarize to new landmarks
 Preview planned destinations with your student
 Give student pictures of desired items when teaching
shopping or how to find a landmark on a new route
 When introducing a new route, make picture book
with the student present in pictures, of key points on
the route
 Use preferred color for background
Visual Novelty cont…
 Keep it visually simple; put only one picture to a
double page
 Use the picture book to review route before practicing
again
 On any new route, allow time for exploration, perhaps
initially with a guide, so the student can become
familiar with new surroundings and you can point out
key areas
 Expect cane skills to temporarily decline when working
in new area until the environment becomes more
familiar
Visual Novelty cont…
 Introduce new cane skills in familiar environment to
help avoid visual distractions
 Watch for evidence of visual and/or physical fatigue
 As vision resolves, tactile and visual exploration will
occur more simultaneously, but only when child is
ready
 Allow for delay between first seeing and then acting
upon a visual target
 Know visual field preferences
Lighting considerations
 Not the classic photophobia
 The presence of shadows creates complexity. Teach
student how to recognize shadows and what causes
shadows to change
 Or avoid times of day when shadows are present
 Reflections from windows, standing water or shiny
surfaces may distract and cause changes in
performance
 Attraction to reflective surfaces can be utilized to mark
landmark or promote visual field expansion
Good News
 Increased support and understanding of CVI including
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State and Federal changes
Children with CVI can improve their skills and use of vision
with the right approach(es)
The brain has plasticity and for children with CVI, this
could mean additional improvements
Recognition that LRE for children with CVI does not
necessarily mean inclusion
Team approach works wonders
Presence of CVI does not always mean cognitive
impairment
Your lessons can be simplified for children with CVI
Resources
 www.aph.org/cvi
 www.afb.org
 www.tsbvi.edu
 →
http://www.tsbvi.edu/component/content/article/124-general/112characteristics-of-cortical-visual-impairment-checklist
 →
http://www.tsbvi.edu/program-and-administrative-resources/3276cortical-visual-impairment-an-overview-of-current-knowledge
 http://drleahyvarinen.com/
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http://www.lea-test.fi/en/assessme/sfracvilect/cviorg.html
www.aerbvi.org
www.familyconnect.org
www.hadley.edu
→
http://www.hadley.edu/Resources_list/Cortical-Visual-Impairment.pdf
www.lilliespad.com
http://www.dblink.org/lib/topics/cvi-bib.htm
www.adaptivedesign.org
This presentation is dedicated to the memory of
Dr. Harvey H. Mar, Developmental Psychologist
(1951-2012)