Sue Douglass. M.S.
Vision Impairment Specialist, Blind Babies Foundation
Presented at
CTEBVI April 24, 2010
Sylvia Santin M.A. and Joyce Nesker Simmons, M. Ed.
Originally published in Journal of Visual Impairment
and Blindness, 1977
•Better communication
•Better hand handling
•More information about what he likes
and doesn’t like
•More communication between home
and school
•More involvement in the activities of his
classroom
•The ability to know what to expect
•Good materials to look at and play with
Communication Assessment
The Communication Matrix, by Charity Rowland, PhD
Available at www.communicationmatrix.org
The Communication Matrix assesses seven levels of
communicative competence
Level I: Preintentional Behaviors
Level II: Intentional Behaviors
Level III: Unconventional Communication
Level IV: Conventional communication – using
gestures and vocalizations
Level V: Concrete symbols – includes use of tangible
objects
Level VI: Abstract symbols – such as Bliss symbols
Level VII: Language – used conventionally
Available in both hardcopy and on-line versions
Assessments
 For fine and gross motor assessment: Functional Scheme, by Lilli
Nielsen, available from LilliWorks Active Learning Foundation, 2517
Blanding Ave., Suite 110, Alameda, CA 94501. (510) 814-9111, Fax: (510)
814-3941. www.lilliworks.com. A vendor here at CTEBVI. No longer
available through Vision Associates.
 For cognitive assessment: Home Inventory of Problem
Solving Skills, by Charity Rowland and Philip Schweigert.
 3. For communication assessment: The Communication
Matrix, by Rowland and Schweigert.
 4. To help teachers design learning opportunities: Design to Learn, an
environmental inventory, by Rowland and Schweigert. All three
available from Design to Learn, www.designtolearn.com or call 1-888909-4030.
How to handle CJ’s hands:
hand-under-hand technique
www.wsdsonline.org/deafblind/huh/huh-overview.html
A child and helper explore a teddy bear
using the hand-under-hand technique
from Barbara Miles “Talking the Language of the Hands to the Hands”
www.nationaldb.org/NCDBProducts.php?prodID=47
Object cues
Give C.J. the very same spoon he will eat with.
This specific spoon says,
“You are about to eat, C.J.”
Anticipation calendar
Uses objects and dissimilar containers
1. Now and Finished: Two containers.
Take the object out of the Now container, use it, then
put it in the Finished container
NOW
NOW
FINISHED
Now, Next, and Finished: Three containers.
Take the object out of the Next container and move it to
the Now container.
NOW
NEXT
Take the object out of the Now container, use it, then
put it in the Finished container.
NOW
NEXT
FINISHED
Activity Calendar
An example: making chocolate milk
Steps:
1. Pour milk in blender.
2. Pour chocolate syrup in
blender.
3. Put lid on blender.
4. Blend for ten seconds.
5. Pour milk in glass.
Symbol:
Milk carton.
Syrup bottle.
Blender lid.
Switch.
Glass.
When is an event a routine?
There is a clear signal to the student that the activity is
starting.
•The steps of the activity occur in the same sequence.
•Each step is done in the same way each time (same
materials, same person, same place).
•Assistance is given the same way each time until the student
is ready for a lower level of prompt.
•The pacing of instruction is precisely maintained until the
activity is finished (no side conversations, going off to get
something you forgot, or spontaneously adding new or
different steps that won't happen the next time the activity is
done).
•There is a clear signal to the student that the activity is
finished.
Millie Smith, Routines, www.tsbvi.edu/Education/vmi/routines.htm
Routines
• build a positively bonded relationship between the
learner and the partner
 provide social experiences that facilitate access to
sensory information
 stimulate the learner’s curiosity
 motivate the learner’s interaction
 maximize the learner’s social availability
 increase the learner’s quality of life
Millie Smith, 1-14-10
Routines
 Develop “agency” skills:
Cognitive skills
Communication skills
Motor skills
Millie Smith, 1-14-10
“Agency skills:” skills that give individuals the ability
to act independently and to make their own free
choices
Going to bed
1. Child is put in crib.
2. Cover is pulled up over him.
3. Child is invited to reach for favorite
squeaky ball and takes it.
4. Mother kisses child good-night.
5. Mother turns out the light and leaves.
You can see this routine for yourself at
www.wsdsonline.org/deafblind/routines/video.html#
video_3
Introducing a new object
 1. Touch the object to a less sensitive part of a child’s
body (e.g., upper arm)
 2. Touch the object to a part of the body closer to your
eventual “destination” (e.g. lower arm)
 3. Move it closer (e.g. back of the hand)
 4. Move it to your final destination (e.g.,palm of hand)
Millie Smith’s three stages of
interacting with objects
1. Paying attention: increase the length of time and the
number of things the child will focus on
2. What does this thing do? The child is a physicist. Does it
fit in my mouth? Make a noise? Come apart? What
happens when I bang it, bite it, throw it?
3. What is this thing for? Does it have wheels so I can roll
it? Can I pretend to feed it? Can you read it to me?
CVI definition
Cortical 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.
From the Blind Babies Pediatric Visual Diagnosis sheet on Cortical
Visual Impairment www.blindbabies.org
Some characteristics children
with CVI may demonstrate
 Eyes look normal, but children do not appear to see
well
 History of interrupted oxygen to the brain or brain
bleed
 May not have full visual fields.
 May prefer objects of some colors over objects of a
different color
 Seem to see familiar objects better than new ones
 Take awhile to “focus in on” an object
More characteristics children
with CVI may demonstrate
 Prefer plain backgrounds and objects with one or two
colors over objects with many colors and much detail
 Look at an object, then turn away from it before
reaching for it
 Appear to look at faces but do not really seem to see
them – recognize people by their voices, etc.
 See better if an object is moving or they are moving (as
in a swing)
 Either avoid light or stare at them, especially overhead
lights, in preference to looking at other things
Phase I: Building Visual Behavior
 Ranges 0-3
 Discover what child will look at
 Develop child’s ability to use vision more frequently to
look at what he or she will look at
 Child only looks at a small repertoire of objects usually
having similar characteristics (may be specific color,
have reflective properties, be moving objects, shown
against a particular background, and visible in a
particular part of child’s visual field)
Phase II: Integrating vision with
function
 Ranges 4-6
 Child now uses vision enough that he or she can use
vision to explore objects and do activities
 Child can use vision in choice-making, self-help
routines, fine motor tasks, cognitive tasks
 Still needs a controlled environment to maximize use
of vision
 Light Box a good tool for children who look at lights
 Usually able to look at faces and respond to facial
expressions
Phase III: Resolving remaining
CVI characteristics
 Range 7-10
 Child may not appear to casual observer to have vision
difficulties
 Still may have reduced visual fields, or be unable to see
at great distances
 Still may have difficulty seeing when there are lots of
objects to look at combined with a “busy” background
 May have trouble recognizing photographs or
drawings of objects he or she can see
 May still have some O & M issues
Long-range planning
Keep in mind: How will the activities you are doing now
make a difference in the child’s
 Control over her or his life?
 Ability to do things independently?
 Connection with others?
 Access to the world?
 In one year?
 In five or ten years?
 In 20-40 years?
Long-range planning
 Was this activity planned together with the child’s
family?
 Is this activity something the child can do at home
with the family?
IEP goals and objectives
 By (date goal will be measured), (conditions under
which goal will be measured), (child’s name) will (do
something observable and recordable) in (number of)
opportunities on (range of) days as measured by (how
achievement or non-achievement will be measured).
 By (June, 2010), (while seated in his Tumbleform
feeder seat), (Asher) will (look at an APH yellow
pompon for 10 seconds) in (4 of 5) opportunities on (4
of 5) days as measured by (teacher record on teachermade chart).
IEP goals and objectives
 By (June, 2010), (when seated in her high chair at the
dinner table, and given her spoon), (Melania) will
(open her mouth in anticipation of being fed with the
spoon) in (5 of 5) opportunities on (4 of 5) days as
measured by (parent record).
 By (June, 2010), (when seated in his Rifton chair at
school) (Isaac) will (reach for a red Mylar-covered
switch to turn on his tape player when the music stops
playing) on (4 of 5) opportunities on (4 of 5) days as
measured by (teacher record on teacher-made chart).
Good luck, and have fun!
Sue Douglass vipreteach@msn.com