The CVI Range A Functional Vision Assessment for Individuals with - PowerPoint PPT Presentation

Vision + function • Phase I elements of color, low complexity, movement are applied to objects that the individual can touch, swat at, reach for, activate, grasp, or make eye contact to create some outcome or response • vision leads/precedes touch • child perceives their power to impact the environment

Phase II environment • reduction of visual and auditory distractions • light+movement+color remain important but with some flexibility in use • some simultaneous sensory information tolerated while viewing • latency decreasing • new objects selected based on visual traits of preferred objects

WPSBC photos

Video #3 Early Phase II 2 1/2 year old girl, twin history of premature birth and white matter injury/PVL mom’s interview information about CVI

Summer’s family

Interview Information 25-question CVI Range interview • mom reports: • 1. Tell me what you do with a toy to get your child interested in it? use the sound on the toy. tap it to bring her attention to it & help her identify where it is. lift it up just lower then eye height & off to the left so she can look through her preferred visual window where both eyes look left. don't have a lot of other sounds around. either show her when she's lying down without distracting light around us. in our bed that has solid color sheets is a good place to get her visual attention. in her wheelchair i'll try to help hold her head so that she doesn't have to focus on holding her head up…but this doesn't usually work as well. If she can touch it & bring it to her mouth this helps her interest in the item also.

3. does your child have a favorite side or a favorite head position? if she's looking at something or trying to then she'll let her head fall to the right shoulder & look to the left with both eyes. 4. does your child usually find objects by looking or by feeling for them? feels for them. she's clued into her sense of sound & touch the most. 5. do you have concerns about the way your child sees? yes.

6. where do you usually hold objects for your child to look at? approx 1 foot or less away from her face & off to the left if i am hoping she'll see it. maybe a few inches down from the height of her eyes…closer to the height of her nose or lips. 7. what are your child's favorite things in your house? she loves people: Mom, sister Jade, Dad, grandparents, etc. when we have the fan going in the kitchen or that light on, she's interested in that. i don't think there's many things that she's visually interested in, it's more people & singing.

8. what, if anything, have doctors told you about your child's eyes? strabismus, early on ROP stage 1. recently CVI. to go ahead & play movies in the car for Jade & maybe switch the girls car seats b/c maybe Summer can see some of it out of her eye gaze to the left if she's sitting in the seat on the right side of the car. I haven't switched them yet though, b/c i don't think she'll be able to see that tiny screen b/c it's too far away & too high & too movies are too quick with too much going on. she just prefers to listen. i would like to find something that she can be visually attuned to during our car rides however.

12. describe how your child behaves around lamps or ceiling fans? she looks at them. 13. are you usually able to identify (be certain of) what your child is looking at? there's a big part of a day where i may not know what she's seeing if she's even sensing her eyes & processing the info. There are times when i can really tell that she's looking at me or the fan or light or someone else. i'm eager to get an iPad & see if she attends visually to the vision games if there's no volume. I feel pretty certain that she will! 14. does your child usually first notice things that move or things that don't move? when people move but i think it's the dorsal vision that you spoke about. if i'm showing her something, i need to hold it still for a long time (probably at least 7 seconds until she sees it & then longer to interpret it) so that she has time to see it & make sense of it.

25. tell me what your child's favorite objects or toys look like. this ? is a trigger for me b/c as many toys as we have in the house & as many of them that Jade loves, I don't know how to answer this question for Summer. I have this deep yearning to find toys that she will really enjoy & have fun engaging with on her own in addition to with me or others. her favorite toys are often the people she enjoys & all singing songs & talking together. she's a happy little girl, not deprived & deeply loved but she doesn't yet have toys that I at least know she really loves. I'd love help in this area.

Summer’s video

Video #3 summary • Summer scores in early Phase II, ~3- 4/10 • CVI characteristics include: • color=.25 gold + red, +/- green • movement=.25, movement almost always necessary • latency=.25

Summer • visual field preferences=.25; +left and superior; +/- right, decreased lower • complexity=.25 • object, 1-2 colors • array, controlled but not darkened • sensory, very interfering • faces, glances toward familiar

Summer • light gazing=.25, light supports visual attention and is also a distraction • distance=.25, attention to a specific target within approximately 1-2 feet, may notice movement of people, pets...at greater distances

Summer • reflexes= .25? hard to see in video, Summer did blink to dad touching forehead • visual novelty=.25, new objects that are visually similar to familiar objects • visually guided reach=.25, occasional sustained visual attention while organizing or actually reaching

Summer’s interventions • will be developed to match, not exceed or be lower than her CVI Range score

Phase III intervention considerations

two big themes • increasing amounts of background information • identifying salient features

Phase III environment • little or no adaptation of familiar environments required • novel sounds or unexpected movement in environment may be a factor in visual attention

Video #4 Griffen 24 weeks gestation, grade III & IV IVH CVI, seizures, language difficulties

Griffen • Initially scored 2 on The CVI Range • Currently scores 8 • Attends both special needs and Montesorri preschool

Griffen’s Phase III sample

salient features supporting literacy • CVI Range score in high Phase II, early Phase III • begin with images of familiar objects • add number of elements & complexity

vary size, placement & number

begin with one object, build to 2 then add small amounts of background