What to do for children with cortical visual impairment (CVI)Opportunities to use vision should be incorporated into your child’s everyday life. For example, you might use a red bowl or plate for each meal. Adding a red ribbon to a bottle for younger children works well. You could also place a red object on or near the diaper changing table, car seat or wheelchair. The key is to place opportunities for the child to see throughout their daily routine. It becomes easier and easier for kids with cortical visual impairment (CVI) to see these objects as they become familiar with them. It can also be helpful to keep one familiar object with your child throughout the day. This allows the child to learn to recognize the object in different environments. Furthermore, children with CVI may tire easily when engaged in visual tasks, which is another reason to keep vision sessions short and frequent throughout the day.
In order to maximize your child’s ability to use vision throughout the day it is important to provide spaces that are free of distractions and visual clutter. Learning to see can be very taxing and difficult for a child with CVI. If the environment is too visually complex or contains competing sensory input it can be difficult for the child to focus on visual clues. You can reduce visual clutter by providing an all black background against which the shiny, bright, highly saturated colored objects can be placed. Try to eliminate noise to give your child the ability to simply focus on seeing.
Because latency is a common characteristic of CVI, children often need a lot of time to respond visually. When presenting an object remember that you may need to wait several minutes before seeing a response. This is especially true of unfamiliar objects. When we first started working with Little Bear he would look at objects for only a second at a time before looking away. What was important was that he would return to the object repeatedly.
It’s key to keep it simple when introducing objects to CVI children. Initially, objects should be only one highly saturated color, like fire engine red. Moving objects are easier to see, and shiny objects can approximate movement. For many children with CVI the use of light is also helpful. For example, shining a flashlight on the target object can draw a child’s attention to it. Over time, you can introduce two familiar colors at the same time, then simple patterns with those colors and so forth.
It is also important to remember that it will be much easier for your child to see if your child is properly positioned. This means giving a child as much support as possible. For example, a child who has to work to hold up his or her head will be less able to focus on using his or her vision. Little Bear seems to use his vision best when lying on his back or being held in a sitting position.
Learn as much as you can about CVI. There is not a lot written for caregivers or families, but there are books and papers written for academics, ophthalmologists and vision specialists. A book we recommend is Cortical Visual Impairment: An Approach to Assessment and Intervention by Christine Roman-Lantzy. There is also an online class offered by Gordon Dutton, M.D., a pediatric ophthalmologist from Glasgow, Scotland. The American Printing House for the Blind offers research papers on CVI. For links to these and other resources, check out our CVI resources page.
We recommend you find a vision specialist who is familiar with CVI. Often this can be accomplished through Early Intervention, your school system or your local government programs. Regular visits to provide information, education and further intervention ideas are very helpful.
http://www.wonderbaby.org/articles/cvi-educational-toolsBy Penny Duffy
Cortical Visual Impairment (CVI) is a form of blindness that is neurological. In other words, a child with CVI may have perfectly healthy eyes, but their blindness is caused by some form of brain injury or malformation.
Of course, this means that CVI can be both difficult to diagnose and difficult to treat. Babies with CVI often have good days and bad days, seeming to see something one day, and completely ignore it the next. Little Bear Sees has a great explanation of CVI characteristics.
But there are some general rules of thumb for making vision easier for kids with CVI. These kids, for example, often prefer clear, crisp images with little background clutter. They respond well to high contrast, bright colors (especially yellow or red), movement and LIGHTS!
While anything dealing with the brain can be confusing, it’s good to know there are some great educational tools that you can use to help your child learn!
Price $399 to $799, depending on the model.
The iPad comes in two sizes: the standard size (9.7 inch display) and the mini (7.9 inch display). Which size you should buy would seem like a simple question, but it really depends on your child and how their visual field is affected. The iPad mini, which is more portable, may work for some children, while the larger screen size of the standard iPad Air may work for others.
The decision to have a larger storage size may also be a wise one depending on how the iPad will be used. Will you be downloading a lot of apps and taking lots of photos and videos? Then you may want to consider getting an iPad with 64 or 128GB, which of course raises the price.
The iPad is remarkable because it is a consumer device that has so many benefits and applications for students with CVI and other forms of blindness. The iPad has many accessibility features including VoiceOver, Zoom, font settings and AssistiveTouch that can be a great benefit for many students with CVI.
But the iPad is really only as good as the apps you’ve downloaded for it. So, which apps should you get?
20 iPad Apps for Children with CVIA tip: Before purchasing any app view other apps by the developer to see if they offer a lite (free) version of the app. Since every kid is different, it’s always best to try out an app for free to see if it will work with your child before you buy it.
#2. Light Box
$135 to $460, depending on the size.
The Light Box is a product sold by American Printing House for the Blind (APH). The Light Box is a common tool used with children with CVI (and other visual impairments). It is a rectangular shaped box with a bright light inside and has a translucent top that allows light to shine through. The light is also adjustable, so you can turn it up or down.
The Light Box comes in two sizes: The standard Light Box is 25 x 15 inches while the Mini-Lite Box is 16 x 12 inches.
What can you do with a Light Box? All sorts of things! APH offers many products to use with the Light Box, including overlays and the Sense of Science program. Sense of Science is a collection of screens you can place on the Light Box that will teach your child about animals, astronomy or plants.
You can also place everyday objects on the Light Box to allow better viewing with the contrast. My daughter loves to place a piece of paper on her Light Box and color over it. She says she can see it so much better.
The possibilities are pretty much endless with it comes to a Light Box and people are always coming up with additional great things to do with this simple but powerful device. For more ideas:
The LightAide™ is a remarkable and innovative educational tool that is perfect for children with CVI. Let’s see…
Simple and clutter free? Check!
Bright colors? Check!
Lights? Double check!!
The LightAide combines many of the best features of both the Light Box and the iPad. It’s large and bright like the Light Box, but also includes interactive and motivating games like the iPad. It’s durable and strong like the Light Box, but easy to use to engage kids in social play and hold a child’s attention like the iPad.
The colorful lights, movement and simple graphics really have a lot of benefits for children with CVI. The LightAide has many different educational benefits. There is software available for literacy and math skills while essential skills like turn taking and visual tracking can be facilitated with a LightAide as well.
Want to know more about how you can use the LightAide with your child? Visit 5 Ways the LightAide is Great for Kids with CVI.
Cortical Visual Impairment Pediatric Visual Diagnosis Fact Sheet™Reprinted with permission from Blind Babies Foundation
DefinitionCortical Visual Impairment (CVI) is a temporary or permanent visual impairment caused by the disturbance of the posterior visual pathways and/or the occipital lobes of the brain. The degree of vision impairment can range from severe visual impairment to total blindness. The degree of neurological damage and visual impairment depends upon the time of onset, as well as the location and intensity of the insult. It is a condition that indicates that the visual systems of the brain do not consistently understand or interpret what the eyes see. The presence of CVI is not an indicator of the child's cognitive ability.
CauseThe major causes of CVI are asphyxia, perinatal hypoxia ischemia ("hypoxia": a lack of sufficient oxygen in the body cells or blood; "ischemia": not enough blood supply to the brain), developmental brain defects, head injury, hydrocephalus, and infections of the central nervous system, such as meningitis, and encephalitis.
CharacteristicsInitially, children with CVI appear blind. However, vision tends to improve. Therefore, Cortical Visual Impairment is a more appropriate term than Cortical Blindness. A great number of neurological disorders can cause CVI, and CVI often coexists with ocular visual loss, so the child should be seen by both a pediatric neurologist and a pediatric ophthalmologist.
The diagnosis of Cortical Visual Impairment is a difficult diagnosis to make. It is diagnosed when a child has poor or no visual response and yet has normal pupillary reactions and a normal eye examination. The child's eye movements are most often normal. The visual functioning will be variable.
The result of an MRI (Magnetic Resonance Imaging) in combination with an evaluation of how the child is functioning visually, provide the basis for diagnosis.
Behavioral/Visual CharacteristicsChildren with CVI have different abilities and needs. The presence of and type of additional handicaps vary. Some children have good language skills and others do not. Spatial confusion is common in children with CVI because of the closeness of the occipital and parietal lobes of the brain.
Habilitation should be carefully planned.
A full evaluation by a number of professionals is essential. The evaluation team could include: teachers (of the visually impaired or severely handicapped), physical therapists (PTs), occupational therapists (OTs), speech therapists, and orientation and mobility specialists.
Common characteristics of visual function demonstrated by children with CVI:
Resources1. "Observations on the Habilitation of Children with Cortical Visual Impairment" Groenveld, M.; Jan, J.E.; Leader, P., Journal of Visual Impairment and Blindness, January, 1990.
2. "Visual Behaviors and Adaptations Associated with Cortical and Ocular Impairment in Children," Jan, J.E.; Groenveld, M; Journal of Visual Impairment and Blindness, April 1993, American Foundation for the Blind.
3. Video: "Issues in Pediatric Ophthalmology: Cortical Visual Impairment (1994)," Child Health and Developmental Media, Inc., 5632 Van Nuys Blvd., Suite 286, Van Nuys, CA 91401.
4. "Cortical Visual Impairment in Children," Good, W.; Jan, J.E.; Luis, D. (1994) Surveys of Ophthalmology. 38:4: 351-364.
AcknowledgmentsJulie Bernas-Pierce, Editor
Dr. Creig Hoyt
Dr. William Good
Off to a Good Start Program
The Pediatric Visual Diagnosis Fact Sheets are sponsored by the Blind Childrens Center and the Hilton/Perkins Program through a grant from the Conrad Hilton Foundation.
Blind Babies Foundation
1200 Gough Street
San Francisco, California 94109
NOTE: Blind Babies Foundation has developed 7 Pediatric Visual Diagnosis Fact SheetsTM on the following topics: Cortical Visual Impairment, Retinopathy of Prematurity, Optic Nerve Hypoplasia, Albinism, Optic Atrophy, Retinal Diseases, and Vision Assessment. One complete set costs $10. Families can get one Fact Sheet free of charge upon request. The Blind Children's Center will soon have the Fact Sheets available on their website at <www.blindcntr.org/bbc>.
Go to Top of Page
Send EMail to SEE / HEAR
Go to Fall 1998 Table of Contents
Encouraging Efficient Use of Vision in Students with CVIEncouraging Efficient Use of Vision in Students with CVI
The following are suggestions to use with infants, young children, and students who have Cortical Visual Impairment (CVI) or who are suspected to have a brain damage related vision loss. These suggestions are intended to encourage students with CVI to use their vision more efficiently. These suggestions correlate loosely with functioning levels/Phases described in Dr. Christine Roman’s book, Cortical Visual Impairment – An Approach to Assessment and Intervention. The reader is encouraged to read through all suggestions, as some students functioning in Phase III might still benefit from suggestions in Phase II or even Phase I, students in Phase II might also benefit from suggestions in Phase I and Phase III, etc. Use the suggestions, especially in Phase I, in conjunction with regularly occurring activities in daily life such as feeding, toileting, grooming and amusement activities. These are general guidelines; no individual student with CVI will ever fit into any one category.
Students Functioning in Phase I
Students in Phase I are generally functioning at a level where they are just beginning to alert to light and objects with movement. The focus in this phase is the building of visual behaviors. Environmental complexity and distractions need to be strictly controlled. Sound can sometimes be used to initiate visual attention, but should be discontinued as soon as the child visually locates the target. Often, the auditory learning channel is the strongest and if a sound source continues longer than necessary, the child may look away to attend to the sound. When the child looks away, he/she discontinues learning through the visual channel and discontinues building the neurological pathway that helps the child make sense of what he/she sees. The same applies to tactual input. The child at this stage may notice visual targets up to about an arm’s length away (24” to 36”). Some suggestions offered in Phase II and Phase III may also be applicable to a child functioning in Phase I.
Students Functioning in Phase II
A student functioning in Phase II is using his/her vision more consistently, but often not efficiently. The teacher and caretaker will want to work towards encouraging the child to use their vision during daily routines and activities. Generally, students at this stage are able to visually attend to targets up to about 4 or 5 feet away. Many of the above considerations may still apply and some suggestions in Phase III may also apply.
light box resources and plans
tactile activity kits
Click heGeneral Materials Used to Adapt Books for Children with CVI
from Paths to Literacy
Please begin by reading:
The following items are general materials that can be used when adapting books for children with cortical visual impairment (CVI):
“Where is the Red Gift Bag?”
“Three Silver Pie Tins and One Red Puff”
“Three Bright Red Pom Poms Lined Up in a Row”
“One Yellow Slinky Bouncing Up and Down”
“Five Little Lights”
“My Favorite Things”
“Clifford’s Family” (Modified, progressive version)
“Get Ready for School” Pegboard Book:
re to edit.
This site offers teaching strategies for lesson planning for stimulating growth in vision and attending.
this web site offers resources for teachers and families, professional development, and teaching strategies.
Resources include an 80 page instructional manual written by an Occupational Therapist that has great ideas for increasing sensory responses. Active Learning
A project developed between Penrickton Center for the Blind in Michigan, Perkins School for the Blind, and the Texas School for the Blind and Visually Impaired provides resources and a community of practice around the work of Dr. Lilli Nielsen and Active Learning. The site includes discussion of Active Learning principles, assessment, implementation, materials, equipment, and other events and resources. Active Learning is most effective for those with significant multiple disabilities and in the 0-48 month developmental level.
Information and resources on CVI, including videos, online classes, and information on the CVI Endorsement.
Source: Perkins eLearning
CVI Web Exercise
This three-part multimedia presentation covers an introduction to CVI, case studies, and intervention strategies.
Source: Texas School for the Blind and Visually Impaired
Information on all aspects of cortical visual impairment (CVI), including introductory materials, CVI products, research, and resources.
Source: American Printing House for the Blind (APH)
National Center on Deaf-Blindness (NCDB)
NCDB is a national technical assistance and dissemination center for information about deafblindness. While most resources focus on the needs of children and youth, there is wealth of information here in the Adult Services section.
Strategies for Promoting Literacy Skills and Students with CVI
Numerous tips, activities, and resources to adapt books and literacy materials for children with CVI.
Source: Paths to Literacy
The Laboratory for Visual Neuroplasticity Research
This research lab focuses on issues of vision impairment and neuroplasticity. Check out the site for reports on current research done by the lab on topics including visual impairment, CVI, spatial cognition, and related topics.
Source: The Laboratory for Visual Neuroplasticity