TRANSCRIPT PROVIDED BY CAPTIONACCESS LLC support@captionaccess.com www.captionaccess.com University of Maryland CBSS Cortical Visual Impairments: Materials Friday, April 10, 2020 * * * * * This transcript is being provided in a rough-draft format. The transcript reflects the transcriber’s best effort to express the full meaning intended by the speakers. It is not a verbatim transcript. * * * * Speaker: Alright. I need to open my PowerPoint and share my screen.
For anybody that has a need, there is an ASL interpreter we will need to pin. I'm seeing nothing else besides my PowerPoint. You're fine. You need you share your screen. Now I'm just talking to a blank screen. I don't like it when I can't see myself. Speaker: You know what, Sandy? You need to be added as a cohost. Now you should have access. If you put your cursor over the bottom you should have a "share screen" button. Speaker: There we go. I can see people over on the side, that's good. I see Becky, okay. You just tell me when to start and I'll start talking. I don't know if you want to introduce anything. It's Friday afternoon and we all have cabin fever. Speaker: We have Dr. Sandra Newcomb as our presenter this afternoon. She is here for everybody's benefit. We are not recording this. You can type in the chat box with questions or unmute yourself and ask. Have at it! Can people raise their hand? Is your primary interest phase 1? Please raise your hand. There's somewhere to click that. You might want to unshare your screen to do that. Where is it? Go to the chat box. Or maybe they can just type in the chat box? In participants there is a "raise hand." Yes, there are some raised hands. There we go! Yes, we are getting some raised hands. If phase 1 is your primary interest, that was about 5-6. Now phase 2. [Counting.] Getting a lot of hands for phase 2. Okay. Phase 3? Okay, so more interest in phase 1 and 2. That's helpful for me to know. I'm assuming everyone can hear me. I'm going to get started now. You have to lower your hand. I've got this weird view of people. Now I can get to it. I'm watching the clock, Jennifer, you might want to give me a time warning when it gets halfway, three quarters, etc. I want people to ask questions so we can make sure we get to the questions you have. I have done this, combined two
presentations. I'm going to talk about some general ideas for each phase. Then I go through characteristics. The main reason this isn't being recorded is I have lots of kid pictures, which I think keeps it interesting. When you think about intervening with child, we always start with assessment. The CVI range is for kids with CVI. You don't do functional assessment with a kid with an ocular impairment along with CVI, CVI is the assessment. This will give us a score of 0-10. I have never seen a 0 or a 10. Kids in phase 1 are somewhere around 0-3, phase 2 is 3-7, phase 3 is 7-10. We have to know what we're doing in each phase. In stage 1, we want to build stable visual functioning. I want you to look at thing. In phase 2, we integrate the vision with function. We want to use vision in all of your routines throughout the day. I have a thermos of water. I did consider wine but went with water. Phase 3 is where you see children using visual curiosity and can use their vision for learning. Now they can look in order to learn about things. Phase 1, we're going to build stable visual function. This takes a high level of environmental control. Sometimes that means lights out and no other noise. You have to plan times of the day when children can practice without other demands. This is unlike the other phases. With phase 1, when those kids are looking, looking is all they can do. You can't have them looking in the context of PT or their meal or circle time in school. You have to make sure there are times of the day when the child can practice vision and there's no other demands put on them. I tell families, are they in their crib, adaptive seating? Place something you know they will look at. I use downtime for vision activities. If the child is tube fed and they need to be seated upright due to reflux or during tube feeding, then that's a good time to give them something to look at. Create a box of toys. Things Eric will look at. Eric is a random name. You create a box of objects; this is what we're going to practice with and nothing else. We use
single colored objects. That means that the objects are all one color. Sometimes that also means there's only one color the child will look at use characteristics of the familiar to introduce something new. If we are going to introduce something else, if it's red and moving, the child may look at it. Make sure the items are close and you have no color in the background, typically black. You allow the child to focus visually without talking to them and without sound in the background. That's a challenge in a classroom. It can be a challenge in a home situation. Now all my poor babies have siblings at home. It gets really challenging. You present objects in the child's preferred visual field. If they will look at things to the right, then you put it in the right. You move objects slightly to get them to look. You use reflective materials. You use light, maybe to initiate looking at object or target. Sometimes I'll shine a light on something. I'm moving the light. You place objects where the child can look and/or touch. In phase 1 we may not be expecting the child to look and touch, but if we can position objects where their hand will accidentally hit it, what we're hoping happens over time is they learn to do that purposefully. I see people use lava lamps; you can get those online. You can get rope lights around the holidays or 4th of July. I like rope lights because if the child touches them later, if they pass phase 1, if they bring them to their mouth, the lights are covered by rubber, so it won't hurt them. I had one family that put a lighted red heart by the child's bed. Mylar balloons are awesome. Typically, we make a frame out of plumbing pipe so you can suspend toys and they move. We use pegboards. I have pictures of all this later on. Wind socks are good because they naturally move. Tri-fold boards are the presentation boards. They are move expensive if they're foam but you can get cardboard. If it's cluttered, you can put up the tri-fold board. In phase 2, now we're going to integrate vision into all the child's routines. For each routine we will think about what we can do to encourage the child to look.
The intervention is not a separate time of day but an overlay in all activities. You plan the vision component of the beginning, middle, and end of all routines. With feeding, I have a red spoon. I'll pause and move it and wait for you to look. Once you look at the spoon, I'll give it to you. You use all the objects you use in phase 1. We got a child to look at something red, now we will put something red on their cup or bottle so they can use vision in those routines. Maybe you put mylar or shiny materials on switches. Limit the number of things you put out at one time. Kids in early phase 2 are just starting to look at things. If too many things are out, it's way too complex. A lot of times we'll use a lightbox. Now we want you to look a little further away. The thing you liked? We will hold it further away and see if you notice it to get some more distance vision. By phase 3, we have curiosity and using vision for learning. At the end of phase 2, when they are visually curious and they go, "what did you bring?" That's visual curiosity. You also see more spontaneous use of vision. In phase 1 and 2 we have to align the stars. By the end of phase 2 and in phase 3, we have kids spontaneously looking at things in front of them. Now the child can look at themselves in a mirror and look at and understand pictures. Pictures are critical for communication, literacy, all kinds of things. Even my high phase 3 kids, this year I have a number of kids who are academic who have CVI, and they still have problems in new environments. Novelty is forever really tough. Particularly when the complexity is high. Remember the preferences they had in color movement? If we're going to get a child to do something really hard, maybe we outline words or put things on a lightbox. Maybe we're going to use an iPad. Highlight words with color, I said that. We use color as an anchor for visual understanding. I can say we're looking for the stop sign. Or, Becky would say that. It's red. Now we can use color to let kids know what they're looking at or for.
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