is proud to present
Cortical Visual
Impairment
Assessment and Intervention
TABLE OF CONTENTS
SECTION ONE: OVERVIEW
OVERVIEW OF CVI
BRAIN DEVELOPMENT AND POTENTIAL PROBLEMS
ASPHYXSIA
POST HEMORRHAGIC VENTRICULOMEGALY OR POST HEMORRHAGIC
HYDROCEPHALUS (PHH)
INTRAVENTRICULAR HEMORRHAGE
PERIVENTRICULAR LEUKOMALACIA (PVL)
HEARING LOSS RISK FACTORS
REFERENCES:
SECTION 2: ASSESSMENT
THE CVI RANGE SCORING GUIDE
Range 1-2
Range 3-4
Range 5-6
Range 7-8
Range 9-10
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Dr. Christine Roman-Lantzy
March 4 & 5, 2010
Dr. Christine Roman-Lantzy
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March 2010
PRE-SCREENING FOR CVI
THE CVI RANGE
CVI RANGE ACROSS CVI CHARACTERISTICS METHOD
Rating I
Rating II
ANSWER GUIDE FOR INTERVIEW QUESTIONS
CORTICAL VISUAL IMPAIRMENT WORKSHOP
CVI SCORING GUIDE
CVI Scoring Guide, cont’d
CVI Scoring Guide, cont’d
CVI Scoring Guide, cont’d
CVI Scoring Guide, cont’d
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ASSESSMENT OF CHILDREN WITH CVI
SECTION 3: IEP & INTERVENTION
INDIVIDUALIZED EDUCATION PROGRAM (IEP) FORMAT
CVI IEP & INTERVENTION WORKSHEET
CVI Planning Table
IEP DEVELOPMENT
Student Example 1: John
Student Example 2: Mary
Student Example 3: Ruby
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LEVELS OF INTRUSIVENESS
LEVELS OF ENVIRONMENTAL SUPPORT IN ASSESSMENT OF CVI
SUGGESTIONS FOR INTERVENTION
CORTICAL VISUAL IMPAIRMENT: IDEAS FOR INTERVENTION
SECTION 4: RESOLUTION CHARTS
CVI RESOLUTION CHART
CVI / ORIENTATION AND MOBILITY RESOLUTION CHART
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Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
SECTION ONE: OVERVIEW
OVERVIEW OF CVI
BRAIN DEVELOPMENT AND POTENTIAL PROBLEMS
ASPHYXSIA
POST HEMORRHAGIC VENTRICULOMEGALY OR POST HEMORRHAGIC
HYDROCEPHALUS (PHH)
INTRAVENTRICULAR HEMORRHAGE
PERIVENTRICULAR LEUKOMALACIA (PVL)
HEARING LOSS RISK FACTORS
REFERENCES:
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OVERVIEW OF CVI
Cortical Visual Impairment
·
Identification, Assessment and Intervention
Remember:
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Parents of children with CVI are the best reporters about their children
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Parents of children with CVI may not have a clear understanding of how CVI occurred
·
Parents of children with CVI have hopes and dreams for their children
Points to Consider:
·
Children with CVI are complex
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Children with CVI require ongoing assessment
·
Not all children with CVI demonstrate ALL behavioral characteristics
CVI- Infancy
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First three years most critical for permanent changes
·
Early identification provides best opportunities to take advantage of plasticity
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
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Don’t wait for medical diagnosis
CVI – Older Students
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Assess strengths and needs carefully
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Continue to make appropriate adaptations as needed
·
Expect improvements
“Go out on a limb. That’s where the fruit is.” – Will Rogers
Identifying CVI

The curse of the normal eye exam

Medical History

Asphyxia

IVH

Infection

Trauma

Presence of the unique CVI behavioral characteristics
CVI Alone?
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Generally, normal eye exam
·
May also exist with: optic nerve atrophy, hypoplasia, or dysplasia
·
CVI may exist in children with ROP
CVI improves or it gets worse…but it never stays the same.
BRAIN DEVELOPMENT AND POTENTIAL PROBLEMS
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
Even medically healthy preterm infants are not
spared learning disabilities, lower IQ's, attention
deficit disorder, distractibility, spatial processing
disturbances, language comprehension and speech
problems, as well as emotional vulnerability and
difficulties with self regulation and self esteem.
• The human cortex begins development around
the 6th week of gestation when the embryo is
< 1.5 cm in length.
• By 10 weeks, cutaneous inversion and
sensitivity becomes apparent - establishing
feedback loops between cutaneous
sensitivity, movement and cortical
development.
• In its prime, the germinal matrix releases as many as 100,000 cortical neurons per day,
tailing off at 24 weeks when neuronal maturation and organization increases
dramatically.
• Each of the established trillion neurons, having migrated, develops dendritic and axonal
interconnections with about 100 other cells, yielding an estimated quintillion synapses.
• New cortical cells generated at a low rate to and beyond 40 weeks. Synapses richly
established until 5 and more slowly until at least 18.
Myelination: seems to occur with peak activity near term but continues until 9 years and
into one's 40s.
Neurotransmitters: more than 2 dozen have been identified. The sensitivity and densities
of neurotransmitters vary widely from brain region to region and are very much influenced
by experience.
The support structure of brain tissue is vulnerable and fragile in the pre-term brain: at 24 28 weeks the germinal matrix is still highly vascular.
When expected environmental inputs are not forthcoming, the involved mechanisms activity
inhibit developing pathways through over activation of existing functional pathways.
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
Source: http://spinacare.wordpress.com/category/pain-and-the-brain/
Figure 2.4
The area of the somatosensory cortex that is devoted to representation of the various parts of
the body surface is indicated by a distorted drawing of the human body, known as a sensory
homunculus. More cortical tissue is devoted to the face and hand than to other parts of the
body; thus, these regions are proportionately larger in the homunculus.
ASPHYXSIA
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
Definition: A condition due to lack of oxygen, resulting in impending or actual cessation of
apparent life. Requires a biochemical index and clinical evidence.
Potential Mechanism During Labor, Delivery, and the Immediate Post Partum Period.
1. Interruption of umbilical circulation (cord compression).
2. Altered placental gas exchange (abruption, insufficiency)
3. Inadequate, maternal side perfusion (hypotension, hypertension)
4. Impaired maternal oxygenation (cardiopulmonary disease)
5. Failure of the neonatal to accomplish lung inflation and make the transition from fetal to
neonatal circulation (RDS, PPHN).
Because APGAR scores at one and five minutes correlate poorly with either cause of outcome,
these scores alone should not be considered either as evidence or consequent to substantial
asphyxia.
CP does not develop in >95% asphyxiated term infants with APGAR's <3 at 5 minutes. In
Western Industrialized countries, rate of cerebral palsy (CP) was 1-2/1000 births in the 1970s
and 1-2/1000 births in the 1990s.
AAP "10% of CP in term infants is associated with evidence of perinatal asphyxia."
Asphyxia
Treatment:
1. Prevention is the most effective treatment
2. There is no "standard treatment at this time.
Ongoing research:
1. Hypothermia
2. Excitatory amino acid antagonists
3.
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
www.nature.com/mp/journal/v10/n2/images/4001633i1.jpg
Figure 1.
Excitatory and inhibitory synaptic events. Presynaptic excitatory neuron with sodium (Na)
channel, adenosine (Al) receptor, influx of glutamine; and exocytosis of glutamate. Presynaptic
inhibitory neuron releasing gamma-amino-buryric acid (GABA). Postsynaptic neuron showing
GABA-activated receptors opening chloride (CI) channels and hyperpolarizing the postsynaptic
neuron. Postsynaptic anion channels, including voltage-sensitive calcium channels (VSCC) and
agonist (glutamate)-operated channels. Glutamate ionotropic receptors include the AMPA
receptor, which allows predominantly NA influx, and the NMDA receptor which regulates
intracellular calcium influx. The metabotropic glutamate receptor mediates activation of
inositol triphosphate, which liberates intracellular calcium. Glutamate reuptake occurs into both
glial cells, where glutamate is converted to glutamine, and into the presynaptic neuron.
POST HEMORRHAGIC VENTRICULOMEGALY OR POST
HEMORRHAGIC HYDROCEPHALUS (PHH)
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
Definition: Progressive ventriculomegaly caused by disturbances in cerebral spinal fluid (CSF)
flow or absorption.
• Incidence of PHH related to degree of IVH
• Ventriculomegaly can occur in the absence of hemorrhage - due to loss of cerebral tissue
• Approximately 60% of post hemorrhagic ventriculomegaly resolves spontaneously
Treatment:
1. Serial spinal taps (13%)
2. Subcutaneous ventricular reservoir (28%)
3. Ventriculoperitoneal shunt (67%)
If shunted:
·
34% died
·
50% of survivors had moderate or severe impairment at 5 years of age
Hydrocephalus (as seen in CAT scan)
Left Image: Hydrocephalus brain scan image. Right Image: Normal Scan.
Source: http://ubiquity-design.com/wordpress/index.php/2009/04/20/medical-word-of-the-day-hydrocephalus/
INTRAVENTRICULAR HEMORRHAGE
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March 2010
-- Overview --
IVH in <1500 gram survivors has decreased from approximately 30% in 1983 to 18% in 1993
(Volpe, 1993).
25-70% of IVH occurs within 6 hours of birth. Sick premature infants have impaired
cerebrovascular autoregulation and fragile blood vessels in the germinal matrix portion of their
brains.
Figure 2
Cross section of brain showing the germinal matrix and ventricular system
Intraventricular Hemorrhages (as seen in a cross-sectional view of the ventricles)
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
1.
PERIVENTRICULAR LEUKOMALACIA (PVL)
Necrosis of white matter in a characteristic distribution:
1. Premature infants
2. Post natal survival for more than a few days
3. Evidence of cerdiorespiratory disturbances
9.2% incidence in infants <32 weeks gestation who lived 7 days.
15% incidence in infants at 28 weeks gestation
4.3% incidence in infants at 32 weeks gestation
Major sequelae:
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
1. Spastic Diplegis - LE v. UE
2. Visual, auditory and somesthetic functions
3. Impairment of subsequent neuronal organization
60-90% of infants with echolucencies and ventricular dilatation have a subsequent deficit.
(PVL) PATHOGENESIS
1. Anatomic: At 24 - 28 weeks gestation, cerebral
arteries have few side branches and less
numbers of short penetrating arteries.
2. Pressure-passive cerebral circulation: In sick
preemie, decreased blood flow with decreased
blood pressure. Difficult to measure cerebral
B.F. clinically
3. Vulnerable cerebral white matter:
Oligodendrocytes are especially vulnerable to
free-radical attack. Preemie's brains have lack
of antioxidant (catalase) defenses.
4.
HEARING LOSS RISK FACTORS
Aminoglycoside Therapy:
Positive relationship in HL as measured by ABR (Solamy, et al 1989)
No relationship (Finitzo - Hieber, et ai 1979)
INHI 2000
·
40.3% of sample participants had aminoglycosides
·
6% had hearing loss
·
1.76% had permanent hearing loss
Birth Weight:
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30% of infants on a ventilator > 7days had middle ear infections (1978)
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May lead to transient hearing loss (THL)
·
INHI 2000
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March 2010
-- Overview --
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PHL group - high percent of children with normal birth weights > 2500 grams
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More cranio-facial anomalies, positive family history, stigmata of neurosensory
syndromes
Most did not require NICU care.
Respiratory Factors:
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15% of infants with persistent pulmonary hypertension of the newborn (PPHN) had
hearing loss.
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Mechanical ventilation for > 10 days, respiratory distress syndrome (RDS) and
bronchopulmonary dysplasia (BPD) were evident in the INHI group that could not be
tested with VRA.
·
9% of all infants with BPD could not complete the protocol due to developmental delay
or visual impairment.
Craniofacial Anomalies:
HL found in 17.6% of Infants with craniofacial anomalies, and 23% of hearing impaired infants
had a craniofacial anomaly. (Norton 2000 - 1/3 mild and 2/3 moderate-profound)
Syndromes:
• Goldenhar syndrome
• Trisomy 21
• Pierre Robin
Family History of Hearing Loss:
14% of hearing impaired infants had a family history of childhood hearing loss.
6.8% of NH infants had a positive family history
Neurosensory Factors:
IVH, ROP and seizures were more evident among hearing-impaired infants compared with
normal hearing cohorts.
Intraventricular hemorrhage (IVH).- up to 20% of infants < 1500 grams
INHI 2000
·
90% of infants with IVH or ROP and
·
83% with seizures (could be tested with VRA)
·
Overall 10% HL in these groups
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March 2010
-- Overview --
(i.e. The presence of one of these neurosensory sequelae is as much of a risk factor as a
positive family history.)
HL with no risk factors: 28% in 2000 to 50% in 1996.
REFERENCES:
Medical Aspects of Developmental Disabilities in Children Birth to Three. 3rd Edition, James
A. Blackman; Aspen Publication, 1997.
Ear and Hearing. Vol 21, No.5, October, 2000
"Outcome of the Very Low Birth-Weight Infant." Clinics in Perinatology, Vol.27, No.2, June
2000.
"Infections in Perinatology." Clinics in Perinatology, Vol., 24, No. 1, March 1997.
Neonatology Pathophysiology and Management of the Newborn Development Outcome.
Avery, G.B. Editor, pp. 1479-1497; Forrest C. Bennett, Author.
Als., H.: Reading the Premature Infant in Developmental Interventions in the NICU. NY
Oxford University Press 1999 18 - 85
Dr. Christine Roman-Lantzy
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March 2010
-- Overview --
Dr. Christine Roman-Lantzy
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March 2010
-- Assessment --
SECTION 2: ASSESSMENT
SECTION 2: ASSESSMENT
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THE CVI RANGE SCORING GUIDE
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Range 1-2
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Range 3-4
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Range 5-6
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Range 7-8
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Range 9-10
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PRE-SCREENING FOR CVI
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THE CVI RANGE
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CVI RANGE ACROSS CVI CHARACTERISTICS METHOD
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Rating I
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Rating II
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ANSWER GUIDE FOR INTERVIEW QUESTIONS
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CORTICAL VISUAL IMPAIRMENT WORKSHOP
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CVI SCORING GUIDE
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ASSESSMENT OF CHILDREN WITH CVI Ideas for a Functional Vision Evaluation Kit58
THE CVI RANGE SCORING GUIDE
Use the following explanations as a guide to score the CVI Range assessment (* indicates that the
CVI characteristic associated with the statement may not resolve if the student has co-existing
ocular visual impairment).
RANGE 1-2
May localize briefly but generally, no appropriate attention of objects or faces
• The student may occasionally glance in the direction of an object but attention is intermittent
and eye-to-object attention occurs rarely, if ever.
• May take into account the CVI characteristics of color, movement, latency, visual fields,
complexity, and visual novelty
Consistently attentive to lights or perhaps ceiling fans
• The student stares into sources of indoor or outdoor light and is unable to attend to other
targets unless the lights are turned off and the student is positioned away from the light.
• May take into account the CVI characteristics of movement, complexity, and light gazing.
Prolonged periods of latency in visual tasks
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March 2010
-- Assessment --
• The student demonstrates a delay in directing vision to a target every time or nearly every
time a new object is presented or a new activity begins
• May take into consideration the CVI characteristic of latency
Responds only in strictly controlled environments
• The student attends to visual targets only when there are no visual, auditory, or tactual
distractions.
• May take into consideration the CVI characteristic of complexity
Objects viewed area a single color
• The student only glances at or fixates on objects that have single color surfaces and the color
may be reported to be the student's favorite or preferred color.
• May take into account the CVI characteristics of color, complexity, and novelty.
Objects viewed have movement and/or reflective properties
• The student only visually attends to objects that move, have moving parts, or are made of
reflective/shiny materials.
• May take into account the CVI characteristic of movement.
*Visually attends in near space only
• The student glances at or visually fixates on objects only when they are presented within 18
inches of their face.
• May consider the CVI characteristics of complexity and distance viewing.
No blink in response to touch and/or visual threat
· The student fails to blink when touched at the bridge of the nose or when an object or open
hand moves quickly on midline toward the face
· May consider the CVI characteristic of visual reflexive responses.
*No regard of the human face
· The student does not look directly into faces; may seem to be "looking through" people.
· May consider the CVI characteristics of complexity and novelty.
·
RANGE 3-4
Visually fixates when the environment is controlled
· The student intermittently demonstrates eye-to-object contact but only when visual, auditory,
and tactual distractions are reduced/do not interfere with visual attention.
· May consider the CVI characteristic of complexity.
Less attracted to lights, can be redirected
· The student may stare at lights but is able to shift attention from the lights when appropriate
visual-targets are presented in controlled environments.
· May consider the CVI characteristic of light gazing
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March 2010
-- Assessment --
Latency slightly decreases after periods of consistent viewing
• The student demonstrates a delay in directing vision to a target some of the time or for
shorter durations of time. Latency may seem to disappear as the student uses vision more
consistently.
• May consider the CVI characteristic of latency.
May look at novel objects if the novel objects share characteristics of the familiar objects
• The student is able to glance toward and/or look at new objects if the new objects have
matching features of color, movement, or low complexity.
• May consider the CVI characteristic of novelty
Blinks in response to touch and/or visual threat but responses may be latent
• The student blinks to touch at the bridge of the nose, and possibly to the swift movement of a
target toward the face but the responses may be delayed rather than simultaneous to the
touch or threat.
• May consider the CVI characteristic of visual reflexive responses.
Has a "favorite" color
· The student clearly continues to most consistently glance toward and/or look at targets that
are made of a single, preferred color over objects of all other colors.
· May consider the CVI characteristic of color
*Shows strong visual field preferences
• The student glances toward and/or looks at objects when they are presented in specific
positions of peripheral and/or central viewing fields. The field preferences are not as limited
or narrow as they were in the 1-2 range.
• May consider the CVI characteristic of visual field preferences.
May notice movement objects at 2-3 feet
· The student glances toward arid/or looks at objects that move in space or made of
reflective/shiny materials but only within 2-3 feet of the student's body. Objects that remain
stationery may be ignored even if they are within the 2-3 foot range.
· May consider the CVI characteristics of movement and complexity.
Look and touch completed as separate events
· The student may attempt to reach for or swat at a target but does not use a visually-guided
reach. The typical pattern is one in which the student glances or looks toward the target then
looks away from the target and while looking away, moves hand/arm in the direction of the
target.
· May consider the CVI characteristic of visual motor.
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March 2010
-- Assessment --
RANGE 5-6
Objects viewed may have 2 to 3 colors
• The student is able to look directly at targets that have pattern of 2 to 3 colors. The student
maintains visual attention on the target for at least several seconds.
• May consider the CVI characteristics of color and complexity.
Light is no longer a distracter
• The student does not gaze into primary sources of light. Special positioning away from light
and/or adjustment of light is no longer required.
• May consider the CVI characteristic of light gazing.
Latency present only when the student is tired, stressed or over stimulated
• The student demonstrates a delay in looking toward a target only when experiencing fatigue,
stress, and/or inappropriate level of multi-sensory input.
• May consider the CVI characteristics of latency and complexity.
Movement continues to be an important factor for visual attention
• The student shows a strong preference for visual targets that move in space or are made of
shiny/reflective material.
• May consider the CVI characteristic of movement.
Student tolerates low levels of background noise
· The student can maintain visual attention even in the presence of low volume, familiar
voices or environmental sounds occur.
· May consider the CVI characteristic of complexity.
Blink response to touch is consistently present
• The student blinks simultaneous with a touch at the bridge of the nose.
• May consider the CVI characteristic of visual reflexive responses.
Blink response to visual threat is intermittently present
• The student occasionally blinks simultaneous with the approach of an object or open hand
moving quickly on midline toward the student's face.
• May consider the CVI characteristic of visual reflexive responses.
*Visual attention now extends beyond near space, up to 4-6 feet
• The student is able to visually locate and/or fixate on certain targets at distances as great as
4-6 feet away. The ability to detect objects or movement at this distance may be dependent
upon the degree of complexity of the viewing environment.
• May consider the CVI characteristics of complexity and distance viewing.
May regard familiar faces when voice does not compete
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March 2010
-- Assessment --
• The student glances at or looks directly into the faces of familiar people but only when the
familiar person is not speaking. If the student looks directly into the face of a familiar
person, attention may be brief.
• May consider the CVI characteristics of complexity and novelty.
RANGE 7-8
Selection of toys/objects is less restricted, requires 1 to 2 sessions of "warm up" time
· The student looks at objects with which they have had little or no prior experience. Objects that
have similar attributes to the objects generally looked at by the student will elicit attention more
quickly than objects that are totally novel.
· May consider the CVI characteristics of complexity and novelty.
Competing auditory stimuli tolerated during periods of viewing - the student may now maintain visual
attention on objects that produce music
· The student is able to look at objects that simultaneously produce music or other sounds.
· May consider the CVI characteristic of complexity.
Blink response to visual threat consistently present
· The student blinks simultaneous with the approach of an object or open hand moving quickly
on midline toward the student's nose.
· May consider the CVI characteristic of visual reflexive responses.
Latency rarely present
· The student seldom demonstrates a delay in detecting a target after it is presented.
· May consider the CVI characteristic of latency.
*Visual attention extends to 10 feet with targets that produce movement
· The student is able to visually locate and/or fixate on certain targets at distances as great as 10
feet away especially with objects that move or are made of shiny materials. The ability to
detect objects with movement at this distance may be dependent upon the degree of
complexity of the viewing environment.
· May consider the CVI characteristics of movement, complexity, and distance viewing.
Movement not required for attention at near
· The student is able to visually locate and attend to objects/visual targets that do not move or are not
made of shiny material within 18 to 24 inches of the student.
· May consider the CVI characteristics of movement and complexity.
*Smiles at/regards familiar and new faces
· The student glances at and/or looks directly at both familiar and novel faces even though eye to eye
contact may not occur.
· May consider the CVI characteristics of complexity and novelty.
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March 2010
-- Assessment --
*May enjoy regarding self in mirror
· The student may glance at and/or look directly at their image in a mirror even though eye to eye
contact may not occur.
· May consider the CVI characteristics of complexity and novelty.
Most high contrast colors and/or familiar patterns regarded
· The student is able to visually attend to/look at objects of any bright color or objects that have
simple, multi-color patterns.
· May consider the CVI characteristics of color, complexity, and novelty.
*Simple books, picture cards, or symbols regarded
· The student visually attends to/looks at 2 dimensional materials that have little complexity and that
include 1 to 2 color images.
· May consider the CVI characteristics of complexity and novelty.
RANGE 9-10
Selection of toys/objects not restricted
· The student is able to visually examine and/or interact with objects of any color and of any surface
pattern.
· May consider the CVI characteristics of complexity and novelty.
Only the most complex environments affect visual response
· The student demonstrates visual curiosity in most environments except in those with an extreme
degree of visual and other sensory input.
· May consider the CVI characteristics of complexity and novelty.
Latency resolved
· The student never has a delay in detecting a target after it is presented.
· May consider the CVI characteristic
No color or pattern preferences
· The student no longer requires special color or pattern cues to facilitate visual attention
on objects.
· May consider the CVI characteristic of color.
*Visual attention extends beyond 20 feet
· The student is able to visually locate and/or fixate on certain targets at distances up to and
possibly beyond 20 feet away.
· May consider the CVI characteristic of distance viewing.
*Views books or other 2 dimensional materials, simple image
· The student is able to visually attend to and/or detect pictures or symbols in books with
simple configurations.
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March 2010
-- Assessment --
·
May consider the CVI characteristic of complexity.
*Uses vision to imitate actions
· The student repeats actions in response to the model or an action performed by another.
· May consider the CVI characteristic of complexity.
*Demonstrates memory of visual events
· The student demonstrates recognition of a person, place, or event that has occurred in
the past.
· May consider the CVI characteristic of co mplexity.
*Typical visual-social responses
· The student has appropriate affective social responses to input from adult or peer facial
expression.
· May consider the CVI characteristic of complexity.
*Visual fields unrestricted
·
·
The student has the full use of both central and peripheral visual fields.
May consider the CVI characteristic of visual field preference.
*Look and reach completed as a single action.
· The student uses a visually guided reach to obtain objects.
· May consider the CVI characteristic o f visual motor.
Attends to 2-dimensional images against complex background
· The student is able to attend to and/or detect pictures or symbols in age appropriate books,
worksheets, or televisions.
· May consider the CVI characteristic of complexity.
PRE-SCREENING FOR CVI
·
·
·
·
·
·
·
·
·
·
Does the child have a history of visual impairments?
Does the child use vision differently than you expect?
Does the child have a normal eye exam (with possible optic nerve differences)?
Does the child "tune out" during large gatherings or trips to busy places (i.e. grocery stores, malls)?
Does the child seem to see better at some times and worse at others?
Does the child use vision more frequently at home rather than almost any other place?
Does the child have favorite things to look at even if the things are not toys? (i.e. ceiling fan, window)
Does the child have a favorite color?
Does the child seem to look through people rather than directly at them?
Does it sometimes take the child longer to "find" something you show him/her than you would
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March 2010
-- Assessment --
·
expect?
Does the child prefer to look at things that move rather than things that are motionless?
*Yes answers indicate a positive relationship with one or more characteristics associated with CVI.
THE CVI RANGE
Student/child's name:
Age:
Evaluator(s):
Evaluation Date:
This assessment protocol is intended for multiple evaluations over a period of time. Suggested scoring (no less
than 3x per school year):
(a) Initial assessment (red)
(b) Second assessment (blue)
(c) Third assessment (green)
*Further assessments will require a new form.
Totals:
Evaluation # 1
(red)
Evaluation #2 (blue) Evaluation #3
(green)
1. Range for Rating 1
1. Total for Rating 2
1. Combine both ratings to get
overall CVI range
1
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-- Assessment --
CVI RANGE ACROSS CVI CHARACTERISTICS METHOD
RATING I
Rate the following statements as related to the student/child's visual behaviors by marking the appropriate
column:
Use the 0 (information obtained through observation of the child/student), I (information obtained through
interview regarding the child/student), and the D (information obtained through direct contact with the
child/student) columns to indicate methods used to support the following scores:
R
The statement represents a resolved visual behavior
+
Describes current functioning of student/child
+/-
Partially describes student/child
-
Does not apply to student/child
CVI Range 1-2: Student functions with minimal visual response
O I
D R
+
+/-
May localize but no appropriate fixations of objects or faces
Consistently attentive to lights or perhaps ceiling fans
Prolonged periods of latency in visual tasks
Responds only in strictly controlled environments
Objects viewed are a single color
Objects viewed have movement and/or reflective properties
Visually attends in near space only
Dr. Christine Roman - Lantzy
22
March 2010
-- Assessment --
No blink in response to touch and/or visual threat
No regard of the human face
CVI Range 3-4: Student functions with more consistent visual response
O I D R
+
+/-
Visually fixates when the environment is controlled
Less attracted to lights, can be re-directed
Latency slightly decreases after periods of consistent viewing
May look at novel objects if the novel objects share characteristics of
the familiar objects
Blinks in response to touch and/or visual threat but the responses
may be latent &/ and are inconsistent
Has a 'favorite" color
Shows strong visual field preferences
May notice movement objects at 2-3 feet
Look and touch completed as separate events
CVI Range 5-6: Student uses vision for functional tasks
O I D R
+
+/-
Objects viewed may have 2 to 3 colors
Light is no longer a distracter
Latency present only when the student is tired, stressed, or overstimulated
Movement continues to be an important factor for visual attention
Student tolerates low levels of background noise
Blink response to touch is consistently present
Dr. Christine Roman - Lantzy
23
March 2010
-- Assessment --
Blink response to visual threat is intermittently present
Visual attention now extends beyond near space, up to 4 to 6 ft.
May regard familiar faces when voice does not compete
CVI Range 7-8: Student demonstrates visual curiosity
O I D R
+
+/-
Selection of toys/objects is less restricted, requires 1 to 2
sessions of "warm-up"
Competing auditory stimuli tolerated during periods of
viewing-the student may now maintain visual attention on
objects that produce music
Blink response to visual threat consistently present
Latency rarely present
Visual attention extends to 10 feet with targets that produce
movement
Movement not required for attention at near
Smiles at/regards familiar and new faces
May enjoy regarding self in mirror
Most high contrast colors and/or familiar patterns regarded
Simple books, picture cards, or symbols regarded
CVI Range 9-10: Student spontaneously uses vision for most functional activities
O I D R
+
+/-
Selection of toys/objects not restricted
Latency resolved
No color or pattern preferences
Visual attention extends beyond 20 feet
Dr. Christine Roman - Lantzy
24
March 2010
-- Assessment --
Views books or other 2 dimensional materials, simple images
Uses vision to imitate actions
Demonstrates memory of visual events
Typical visual-social responses
Visual fields unrestricted
Look and reach completed as a single action
Attends to 2-diemensional images against complex
background
RATING II
Determine the level of CVI present or resolved in the 10 categories below and add total score. Rate the
following CVI categories as related to the student/child's visual behaviors by circling the appropriate
number (CVI Resolution Chart may be useful as a scoring guide):
0.00
Not Resolved, usually or always a factor affecting visual functioning
0.25
Resolving
0.50
Resolving, sometimes a factor affecting visual functioning
0.75
Resolving
1.00
Resolved, not a factor affecting visual functioning
Not
Resolved
1. Color
Comments:
1. Movement
Comments:
1. Latency
Resolving
Resolved
0
.25
.5
.75
1
0
.25
.5
.75
1
0
.25
.5
.75
1
Comments:
Dr. Christine Roman - Lantzy
25
March 2010
-- Assessment --
1. Visual Fields
Comments:
1. Complexity
Comments:
1. Light Gazing
Comments:
1. Distance Viewing
Comments:
1. Visual Reflexive Responses
0
.25
.5
.75
1
0
.25
.5
.75
1
0
.25
.5
.75
1
0
.25
.5
.75
1
0
.25
.5
.75
1
0
.25
.5
.75
1
0
.25
.5
.75
1
Comments:
1. Visual Novelty
Comments:
1. Visual Motor
Comments:
ANSWER GUIDE FOR INTERVIEW QUESTIONS
1. Tell me what you do with a toy to get __________ interested in it.
CVI characteristic area: use of movement or visual fields
+ Responses:
· I move it, shake it back and forth, and activate it.
· I present it to __________'s right or left side & move it or try to get it to make
motion.
- Responses:
· I set it up in the center of where __________ is positioned.
· I put it in his/her hand.
· I put it in front of him/her.
· He/she notices the toy and then I bring it to him/her.
2. When you show __________ something, how do you know he/she sees it?
CVI characteristic areas: visual attention/non purposeful gaze
+ Responses:
· I'm not always sure he/she sees what I show to him/her.
· When I show him/her favorite (familiar) objects, he/she stops doing other things.
· He/she smiles or moves toward the object.
· I don't think there are many things he/she likes to look at.
-Responses:
Dr. Christine Roman - Lantzy
26
March 2010
-- Assessment --
·
·
·
He/she likes most things as long as I move the toy close enough.
He/she seems to like the same things other babies like.
He/she looks right at the toy and gets "excited".
3. Does __________ have a favorite side or head position?
CVI characteristic areas: visual field preference or presence of addition disability
+ Responses:
· He/she seems to generally keep his/her head positioned to one side.
· He/she usually notices things when I place the object at right/left side.
· Yes, I think he/she is going to be right/left handed.
- Responses:
· No, he/she uses both right/left sides.
· I haven't noticed a favorite side.
· The doctor told me she might have trouble seeing at right/left/center.
4. Does __________ usually find toys by looking or by feeling for them?
CVI characteristic areas: visually guided reach or visual complexity
+ Responses:
· He/she usually searches for toys without looking where his/her hand is aiming.
· If something touches his/her hand, he/she grasps it.
· He/she seems to look away before moving his/her hand in the direction of the toy
- Responses
· If the toy is within view, he/she will look and reach for it.
· No, he/she seems to look & reach/swat/bat at toys.
5. Do you have concerns about the way__________ sees?
CVI characteristic areas: appearance of eyes/normal eye exam
+ Responses:
· Yes.
· The doctor told us that his eyes are normal but he/she may not understand what he/she
sees.
· He/she seems to have better and worse times when he/she seems to see.
· I think he/she will outgrow the problem with his/her eyes.
- Responses:
· No, the doctor explained that glasses (surgery, etc.) will help him/her.
· I was concerned but I'm not concerned about his/her vision now
6. Where do you usually hold toys for __________ to look at?
CVI characteristic areas: visual field preference or visual complexity
+ Responses:
Dr. Christine Roman - Lantzy
27
March 2010
-- Assessment --
· I usually hold things at right/left/center.
· He/she seems to pay attention to objects when I hold the toy at right/left/center.
· I usually hold things close and/or at right/left/center.
- Responses:
· I usually hold them up close because the doctor said he/she has trouble seeing far away
(or far away because doctor said . . . .)
· I usually put them where he/she can reach the toys.
· In playpen, crib, on floor, etc.
7. What are __________ 's favorite things in your house?
CVI characteristic areas: light gazing or non-purposeful gaze or the use of movement or visual
novelty
+ Responses:
• He/she likes the ceiling fan.
• He/she looks at overhead lights, lamps, windows.
• He/she seems to like to watch the television.
• He/she likes to look at mirrors/mirror-like, reflective things.
- Responses:
· He or she notices everything around him/her; "never misses a trick".
· The doctor said he/she will notice large or bright things.
· He/she reacts when someone new comes over.
8. What, if anything, have doctors told you about __________‘s eyes?
CVI characteristic area: appearance of eyes/normal eye exam
+ Responses:
· The doctors told me that his/her eyes are normal but we can't be sure how well he/she
understands what he/she sees.
· The doctors told me that we'll know more about his/her vision as he/she gets older.
· The doctors say his/her eyes are fine.
· The doctors say he/she has optic nerve atrophy/hypoplasia/dysplasia.
- Responses
· The doctors say he/she is diagnosed with __________.
9. When does __________ usually like to look at things?
CVI characteristic areas: visual novelty or visual array/visual complexity
+ Responses:
· He/she is most alert when the house is quiet (other members at school or work).
· He/she seems to be more aware at night.
· He/she likes to look at things after he/she is rested, is fed.
· He/she likes to look at things when her favorite toys are presented
· He/she likes to look at things in his/her crib (if same set of toys are generally present
in crib).
- Responses
· He/she likes to look at things that are new or he/she is curious about.
Dr. Christine Roman - Lantzy
28
March 2010
-- Assessment --
·
·
He/she likes to look at things any time of the day.
He/she likes to look at things when the toys are close enough or bright enough
(according to EI or medical suggestion).
10. What color are the things __________ likes to look at most?
CVI characteristic areas: color preference or visual novelty
+ Responses:
· He/she seems to like things that are yellow/red (or any consistent color).
· He/she likes black and white objects.
· He/she likes toys that are shiny/mirrored.
· He/she only likes 1 or 2 toys.
- Responses:
· I've never noticed that __________ likes a certain color.
· The doctor told me/us that he/she will see bright colors best.
11. What does __________ do when he/she is near mirrored toys or very shiny objects?
CVI characteristic areas: light gazing, or use of movement, or color preference
+ Responses:
· He/she turns toward/looks at them.
· He/she swats at them.
· He/she smiles, quiets; he/she seems to like sh iny things.
- Responses:
· The doctor told us that he/she might find those toys interesting.
· They seem to be "too bright" for him/her.
· Bright, shiny things seem to bother his/her eyes.
· He/she likes them about as much as other things.
12. Describe how __________ behaves around lamps or ceiling lights.
CVI characteristic area: light gazing or non-purposeful gaze/visual attention
+ Responses:
· He/she stares at them, looks at them, notices them often.
· He/she moves toward them or positions his/her body in the direction of the light.
· He/she will lie on his/her back and watch the light for long periods of time.
- Responses:
· He/she squints or closes his/her eyes.
· I haven't noticed anything in particular.
· He/she turns away from the lights.
· The doctor said that he/she might notice lighted things.
Dr. Christine Roman - Lantzy
29
March 2010
-- Assessment --
13. Are you usually able to identify (be certain) what is looking at?
CVI characteristic areas: non-purposeful gaze/visual attention
+ Responses:
· I'm not sure what he/she looks at or is interested in.
· Sometimes it seems like he/she is looking "through" things not "at" things:
· I can tell when he/she is looking at things some of the time or when the things are
favorite objects.
· He/she seems to notice things when the house is quiet/when there isn't much activity.
- Responses
· Yes, I am usually able to identify what __________ is looking at.
· I can identify things if they are close enough to __________ to be
· able to see the object(s) clearly.
· He/she seems to be interested in most objects or activities going on around him/her.
14. Does __________ usually first notice things that move or things that don't move?
CVI characteristic areas: use of movement and visual field preference
+ Responses:
· He/she likes toys or objects that move/spin/are activated.
· He/she seems to notice people/pets as the move around the room.
· He/she seems to like to watch the action/color/visual array on the television.
- Responses:
· I never noticed either way.
· He/she seems to "lose" where I am in a room unless I stand still.
· He/she likes his/her stuffed animals that are (in crib, on dresser, etc.)
· The doctor told us that he/she sees best using peripheral or movement vision.
15. How does __________ position his/her head when you think he/she is looking at something?
CVI characteristic area: visual field preference
+ Responses:
· He/she seems to (slightly) turn his/her head even when the object is straight ahead of
him/her.
· He/she favors his/her right/left side of his/her body.
· I usually put things at his/her right /left side.
- Responses:
· The doctor told us that he/she might see better at his/her right/left/center.
· No, I just show the toy to him/her as I would with any baby.
· It doesn't seem to matter where I place a toy; he/she notices things he/she is interested in.
16. Do you think __________ has a "favorite" color?
CVI characteristic area: color preference
+ Responses:
Dr. Christine Roman - Lantzy
30
March 2010
-- Assessment --
· Yes, yellow/red/blue, etc.
· He/she prefers Big Bird (or any single toy that is primarily one color).
· He/she likes black & white pattern toys.
- Responses:
· No, I haven't noticed a favorite color.
· He/she seems to like toys with lots of colors.
· The doctor told us that he/she might see bright colors best.
17. Does __________ seem to notice things more at home or more in new places?
CVI characteristic areas: visual array/visual complexity and non-purposeful gaze/visual
attention
+ Responses:
· He/she is more alert in the familiar surroundings of home.
· He/she seems to sleep a lot when we're out in new places.
· He/she doesn't seem to notice things as much in new places, he/she prefers to be at
home.
· He/she seems bored in new places.
- Responses:
· He/she seems more alert in new places.
· He/she seems to get bored with the things he/she has at home.
· He/she smiles and seems excited when we're out.
18. Describe how __________ positions his/her head when swatting or reaching toward something.
CVI characteristic areas: visual motor and visual field preference
+ Responses:
· He/she doesn't usually reach or swat at things.
· He/Mie doesn't look in the direction of his/her hand.
· It seems like he/she looks or swats/reaches but doesn't do them together.
· He/she turns his/her head when trying to reach for something.
- Responses:
· He/she looks at the thing he/she swats/reaches toward.
· The doctor told us that he/she might turn his/her head in order to see or reach for
something.
· He/she positions his/her head in the center of his/her body.
19. How does__________ react when you give him/her new things to look at?
CVI characteristic areas: visual complexity/visual array and visual novelty
+ Responses:
· He/she doesn't seem to like new things at first.
· He/she seems to prefer his/her old, favorite toys more than new ones.
· He/she learns to like them after a while.
- Responses:
· He/she loves new toys; he/she gets bored with the old ones quickly.
· He/she usually likes new toys.
Dr. Christine Roman - Lantzy
31
March 2010
-- Assessment --
·
He/she smiles and/or gets excited when there are new toys to play with.
20. Do you position __________ in a certain way to help him/her see things better?
CVI characteristic areas: visual field preferences and visual complexity/visual array
+ Responses:
· Usually on right/left side
· I sometimes position him/her away from things that distract his/her attention.
· I position him/her close to the things he/she is trying to look at
- Responses:
· No, there isn't a usual or special position.
· The doctor told us that we should move him/her closer to things; or, we should move
the things closer to him/her.
· We position him/her on his/her back.
21. Have you even been concerned about the way __________ ‘s eyes move?
CVI characteristic areas: normal eye exam/appearance of eyes
+ Responses:
· No, his/her eyes seem to move together.
· People tell us that his/her eyes are pretty.
· When he/she was younger his/her eyes didn't always look straight and seemed to move
in an irregular pattern, but he/she has outgrown that
- Responses:
· No, the doctor didn't mention that.
· Yes, the doctor said that it's part of his/her eye condition.
22. What does __________ do when there are many toys in front of him/her to look at?
CVI characteristic areas: visual complexity/visual array and visual novelty
+ Responses:
· He/she usually just plays with the one(s) we place in his/her hand.
· He/she seems to just look away.
· He/she can't choose which one to play with.
· We think he/she likes to play with one or two things at a time.
· He/she gets fussy when there's a lot going on around him/her.
- Responses:
· He/she plays a little bit with each one.
· He/she picks out his/her favorite ones(s) to play with.
· He/she smiles/gets excited.
23. Tell me about the faces __________ prefers to look at.
CVI characteristic areas: visual novelty and visual complexity/visual array
+ Responses:
· He/she doesn't usually look at faces.
· He/she only looks at (1 or 2 familiar faces) - mom/dad/siblings.
Dr. Christine Roman - Lantzy
32
March 2010
-- Assessment --
· He likes his own face when I show it to him in a mirror.
- Responses:
· He/she loves all kinds of faces.
· He/she enjoys other babies/children's faces.
· He/she usually notices voices first because his/her eye condition makes his vision less
helpful when recognizing familiar people.
24. If __________ had his/her own toy to look at and a new toy to look at, what do you think
he/she would do?
CVI characteristic areas: visual novelty and visual complexity/visual array
+ Responses:
· I think he/she would prefer his/her own toy.
· He/she has "strong opinions" about what he/she likes to look at and he/she likes his/her
favorite old toys.
· He/she has just a few toys that are favorites and he/she likes them more than new ones
· We have difficulty finding new toys that he/she likes as much as, the old ones.
- Responses:
· He/she would prefer to look at the new toy.
· He/she only plays with his/her toys for a brief time and then he/she seems to get bored so
we offer him/her something new.
· I'm not sure.
· It depends on the toys presented; the doctor told us he/she may prefer bright or lighted
toys.
25. Tell me what __________ 's favorite toys or objects look like.
CVI characteristic areas: color preference, visual novelty, visual complexity/visual array, use of
movement
+ Responses:
· He/she likes toys that . . . (descriptions of toys that produce movement, those that have a
consistent predominant color).
· Toys that are simple in visual array with little pattern change.
· Toys that have repetitive black/white patterns.
· He/she prefers (1, 2, or 3) favorite toys with similar color, pattern or movement features.
- Responses:
· He/she likes a variety of toys (with little similarity in features of color, pattern)
· The doctor told us he/she would see lighted, movement, etc. toys best.
· He/she likes anything we give him/her to play with.
CORTICAL VISUAL IMPAIRMENT WORKSHOP
Date:
Student:
Dr. Christine Roman - Lantzy
33
March 2010
-- Assessment --
Age:
Diagnostic information/history:
Parent/teacher impression regarding student's visual performance:
Behaviors associated with CVI:
Visual field observations
Eccentric viewing?
Field neglect?
Best position for people to approach the student?
Best position for materials?
Best position for self help routines?
Visual Acuity Behaviors
Uses near viewing to reduce complexity?
Notices favorite objects/people within _____ feet? within _____ inches?
Dr. Christine Roman - Lantzy
34
March 2010
-- Assessment --
Attends best when visual target has movement properties?
Color
Favorite color/colors?
Complexity
Using a "favorite" and familiar object, how many other objects can be presented with
attention maintained?
Pattern/complexity of objects tolerated
Use high contrast, low complexity backgrounds?
Tolerance of multisensory inputs
Visual?
Tactual?
Auditory?
Olfactory?
Novelty
Familiar, generally viewed targets:
Next targets to try:
Targets to avoid:
Visual Motor Hand preference
Motor limitations
Tactual sensitivities
Quality of eye hand performance
Lighting
Light gazing behaviors?
Methods to use light for increased attention
Dr. Christine Roman - Lantzy
35
March 2010
-- Assessment --
Lighting preferences
Type
Position
Intensity
Visual Latency
Present?
Does latency change according to time of day, type of activity, amount of sensory
competition?
Reflexive visual behaviors
Visual blink response
Visual threat
Eye movements
Pupil responses
Overall CVI Rating
1
2
3
4
5
6
7
8
9
10
Recommendations for programming:
Dr. Christine Roman - Lantzy
36
March 2010
-- Assessment --
CVI SCORING GUIDE
Statement
R
+
+/-
--
Phas
e
Rang
e
CVI
Characteristic
May localize
but no
appropriate
fixations of
objects or faces
Fixates on
objects or faces
May occasionally glance in
the direction of an object or
face but attention is
intermittent and eye-toobject attention occurs rarely
Brief, inconsistent
attention toward an
object or face/may
be only by report
No attention in the
direction of any
object or face by
report or
observation
I
1-2
Color, movement
latency, visual
fields, complexity,
novelty
Consistently
attentive to
lights or perhaps
ceiling fans
Able to look at
targets in the
presence of
primary sources of
light
Stares into sources of indoor
or outdoor light and is
unable to attend to other
targets unless the lights are
turned off or the student is
positioned away from the
light
Occasionally able to
attend to nonlighted targets even
in the presence of
primary sources of
light
No attention on
light or any other
target
I
1-2
Movement,
complexity, light
gazing
Prolonged
periods of
latency in visual
tasks
Little or no
delay in
directing vision
to a target
Demonstrates a delay in
directing vision to a target every
time or nearly every time a new
object is presented or a new
activity begins
Delay in directing
vision to a target
occurs only when
tired, stressed, ill, or
hungry
Profound delay in
directing vision to
a target- only
rarely seems to
view a target
I
1-2
Latency
Responds only in
strictly
controlled
environments
Attends to visual
targets in the
presence of more
than one visual
target, sound, or
touch
Attends to visual targets only Occasional attention
when there are no visual,
to visual targets in
auditory, or tactual distractions the presence of
certain/familiar
visual, auditory or
tactual distractions
No consistent
visual attention to
any visual
targets
I
1-2
Complexity
Objects viewed
are a single
color
Looks at objects
that are any color
and/or more than a
single color
Glances at or briefly
fixates on single color objects
—may be reported to be
favorite color
No consistent
visual attention to
visual targets of
any particular
color
I
1-2
Color,
complexity,
Novelty
No consistent
visual attention to
moving or nonmoving targets
I
1-2
Movement
Glances at or
briefly fixates on
objects that are
favorite color and
occasionally other
colors.
May also glance at or
briefly fixate on
objects that havemore
thanasingle color
surface
Objects viewed
have movement
and/or
reflective
properties
Looks at objects that
are neither shiny
nor
moving
Dr. Christine Roman - Lantzy
Only looks at objects that move,
have moving parts, or are
made of reflective/shiny
materials
May need moving
and/or shiny objects to
initiate visual
attention.
Occasional attention
on objects without
movement
properties
37
March 2010
-- Assessment --
R
+
+/-
--
Phase
Range
Statement
Visually attends
in near space
only
Looks at objects
that are beyond 18
inches away
Dr. Christine Roman - Lantzy
Glances at or briefly fixates Occasional glance or
on objects only when they are fixation on objects
presented within 18 inches
beyond 18 inches
38
No consistent
visual attention to
objects at any
distance
I
1-2
CVI
Characteristi
c
Complexity,
distance
viewing
March 2010
-- Assessment --
No blink in
response to
touch and/or
visual threat'
Blinks when touched at Fails to blink
bridge of the nose
or in response to a
moving target on
midline toward the
face
Occasional blink in
response to touch or
threat
Eyes not open
I
1-2
Visual reflexes
No consistent
attention on
targets of any kind
I
1-2
Complexity,
novelty
No regard of the
human face *
Looks directly into
No attention to human faces, may Occasional glances
faces, even if briefly seem to "look through" people
into faces even if it is
or inconsistently
not eye to eye contact
Visually fixates
when the
environment is
controlled
Establishes eye to
object contact on
familiar or novel
objects or human
face even in the
presence of visual or
other sensory
stimuli
Intermittent eye to object contact
but only when visual, auditory,
and tactual distractions are
reduced/eliminated
Small degree of additional
sensory input may be
tolerated while viewing
Occasional eye to object May turn in the
contact but conditions direction of a
for fixations may vary target but no eye
to object contact
I-II
3-4
Complexity
Less attracted to
lights, can be
redirected
Does not stare at
primary sources of
light
May stare at lights but is able to
shift attention from lights when
appropriate visual targets are
presented in controlled
environments
Rare occasions when
primary sources of light
must be eliminated
for visual attentionon a
target to occur
All primary
sources of light
must be
eliminated
I-II
3-4
Light gazing
Latency slightly
decreases after
periods of
consistent
viewing
Rarely if ever a delay
in directing vision
toward a familiar
object
Demonstrates a delay in directing
vision to a target some of the time
or for shorter durations of time
Latency may fade as vision is used
more consistently
Delay in directing vision
toward target occurs
frequently but not every
time a familiar target is
presented
Delay in directing
vision toward a target
is always present
I-II
3-4
Latency
May look at
novel objects if
the novel objects
share
characteristics
of the familiar
objects
Able to glance towardor
haveeye to object
contact on objects
never previously
seen that may or may
not resemble
"favorite" objects
Able to glance toward or have eye
to object contact with new
objects if the new objects have
matching features of color,
movement, or low complexity
Able to glance
toward or have eye to
object contact with
objects that have few
similar traits butmayshare
at least one matching
element or color,
movement,or
complexity
Able to glance
toward or have eye
to object - contact
only with a small set
of highly familiar
objects
I-II
3-4
Novelty
Blinks in
response to
touch and/or
visual threat but
responses may be
latent
Blinks immediately
when touched at the
bridge of the nose
and/or when a target
moves quickly toward
face
Blinks to touch at bridge of
the nose and possibly to the quick
movement of a target toward the
face but responses may be
delayed or slightly inconsistent
Blinks to touch but not to Does not blink
target moving quickly
consistently to either
toward face
touch at bridge of
nose or to target
moving quickly
toward face
I-II
3-4
Visual reflexes
Dr. Christine Roman - Lantzy
39
March 2010
-- Assessment --
Has a "favorite"
color
Visual attention to
targets not
dependent upon a
particular color
Continues to most
consistently glances toward
or eye to object contact on
targets made of a single,
preferred color over objects of
all other colors
Favorite color may
be necessary to
initiate looking
Some part of the
target is made of the
"favorite" or preferred
color
No consistent
attention to
objects
I-II
3-4
Color
CVI SCORING GUIDE, CONT’D
Statement
R
+
+/-
--
Phase Range
CVI
Characteristic
Shows strong
visual field
preferences *
Visual attention
Glances toward and/or eye to
occurs equally in all object contact on targets
fields
when presented in specific
positions of peripheral and/or
central viewing fields
Preferences not as rigid as in 1-2
range
Glances toward or
eye to object contact
on targets in most
viewing positions
with a slight
preference for the
original preferred
position
Glances toward
or eye to object
contact in one
viewing field
only
I-II
3-4
Visual field
preferences
May notice
movement
objects at 2-3
feet
Visual attention on
objects that do not
move or have
reflective
properties at
distances up to 3
feet or beyond
Glances toward or eye to
object contact on objects
that move in space or are made
of reflective/shiny materials
& at distances up to 3 feet
Movement,
reflective
properties required to
initiate visual
attention
Movement, or
reflective
materials
necessary and
viewing distance
is within 18
inches of face
I-II
3-4
Movement,
complexity
Look and touch
completed as
separate events
Even if
inconsistently
reach and touch
occur as a simultaneous
event
Attempts to reach or swat at a
target but does not use a
visually guided reach
Look, look away, reach pattern
used
Occasional
visually guided
reach
No attempts to
reach or swat at
targets
I-II
3-4
Visual motor
Objects viewed
may have 2-3
colors
Visual attention on
multi-color or
multi-pattern
objects with or
without preferred
color
Looks directly at targets
that have a pattern of 2 to 3
colors
Preferred color is at least
oneelement ofthepattern
Looks directly at
targets that have 2 and
occasionally 3 colors
Preferred color is
always one of the
colors
Visual attention
only on single,
preferred color
objects
II
5-6
Color,
complexity
Light is no
longer a
distracter *
Normal responses No light gazing behavior
to high and low
levels of light
Occasional gazing at
primary sources of
light
Light gazing
occurs
consistently
II
5-6
Light gazing
Dr. Christine Roman - Lantzy
One element of the
object may be
moving, reflective,
shiny
40
March 2010
-- Assessment --
Latency present
only when the
student is tired,
stressed or over
stimulated
No delay in
directing visual
attention to a
familiar or
noncomplex
target
Delay In directing visual attention
toward a target only when
experiencing fatigue, and/or
inappropriate levels of multisensory input
Occasional delay in
directing visual
attention to a target
Consistent delay
in directing visual
attention to a
target
II
5-6
Latency,
complexity
Movement
continues to be
an important
factor for visual
attention
Movement
reflective, shiny
materials not
required for visual
attention near or
up to 6 feet
Visual attention most consistent
with materials that move, are
reflective or shiny
Some element of movement
necessary, entire target does
not have to be movement or
reflective
Small element of
movement may
help establish or
maintain visual
attention
Only materials with
movement
elements
establish or
maintain visual
attention
II
5-6
Movement
Tolerates low
levels of
background
noise
Visual attention
established &
maintained in
typical multi
sensory
environments
Visual attention maintained
even in the presence of low
volume sound, familiar voices
or familiar environmental
sounds
Occasional ability to
maintain visual
attention in the
presence of sound
One or two
particular sounds
tolerated during
viewing, many not
No or little visual II
attention in the
presence of other
sensory inputs
5-6
Complexity
CVI SCORING GUIDE, CONT’D
Statement
Blink response
to touch
consistently
present
Slink response to
visual threat
intermittently
present
Visual attention
now extends
beyond near space,
up to 4-6 feet *
R
+
+/-
Phase Range
CVI
Characteristic
II
5-6
Visual reflexes
Blink to visual threat present Blink to threat
No blink to
—50% of attempts
occurs but less than visual threat
50% of attempts
II
5-6
Visual reflexes
Can visually locate or
fixate on certain targets at
distances as great as 6 feet
Ability to detect objects or
movement
II
5-6
Complexity,
distance
viewing
Blink to touch
present, visual
threat (blinks as
target moves
quickly toward
the face)
inconsistently
present
Blinks simultaneous to
touch at bridge of nose
consistently
Blink to visual
threat
consistently
Visual attention or
eye to object
contact with
targets beyond a
distance of 6 feet
Emerging pattern of
blink to touch
present
Occasional ability to
locate or fixate on
targets as great as 6
feet even when the
background is
visually noncomplex
Attention at 4-6 feet may be
dependent upon the degree
of environmental complexity
Dr. Christine Roman - Lantzy
--
41
Occasional or
absent blink to
touch
Visual attention
or eye to object
contact within 3
feet
March 2010
-- Assessment --
Eye to face
May regard
familiar faces when contact, even if
voices do not compete inconsistent and may
be possible
simultaneous with
speech
Glances at or looks directly
into faces of familiar
people but only when the
familiar person is not
speaking
Glances at or looks No regard to the
directly into faces but human face
responses are
inconsistent or
fleeting
II
5-6
Complexity,
novelty
Selection of objects
less restricted,
requires 1 to 2
sessions of "warm
up" time
Novel objects
that match
complexity
requirements are
visually regarded
Looks at new objects that have
attributes of the familiar
objects
After 1-2 presentations of the
object, it becomes
recognized immediately
Look at new objects
that have attributes
of the familiar ones
but requires more
than 2
presentations before
it becomes
recognized
immediately
Looks at familiar
objects, novel
objects must
closely resemble
the familiar ones
III
7-8
Complexity,
novelty
Competing
auditory stimuli
tolerated during
periods of viewing
May now maintain
visual attention on
objects that
produce music
No amount of
sensory
information
interferes with
visual attention
Able to look at objects that
simultaneously produce music
or other sounds
Occasionally able
to maintain visual
attention while
other sensory
inputs compete
Particular types of
sensory inputs may
continue to
interfere with
visual attention
Visual attention
dependent on low
or no additional
sensory input
III
7-8
Complexity
Blink response to
visual threat
consistently
present
Blinks to
approach of
unexpected
inputs within a
complex
environment
Blinks simultaneous to the
approach of an object or open
hand moving quickly on
midline toward the face
Occasionally
blinks to the
approach of an
object or hand
moving quickly on
midline toward the
face
No blink to threat
III
7-8
Visual reflexes
CVI SCORING GUIDE, CONT’D
Statement
R
Latency rarely Delayed
response to
present
visual input
never occurs
Dr. Christine Roman - Lantzy
+
Seldom demonstrates a delay in
detecting a target after it is
presented
+/Novel objects,
complex
environments, or
fatigue may increase
degree of delayed
response
42
--
Phase
Rang
e
Delayed response
to new and familiar
targets continues to
exist
III
7-8
CVI
Characteristic
Latency
March 2010
-- Assessment --
Visual attention
extends to 10
feet with targets
that produce
movement *
Visual attention
beyond 10 feet
and/or visual
attention to 10
feet with targets
that are stable
Occasional visual
attention on targets at
10 feet, generally
when the environment
is controlled for other
sensory inputs
No visual attention
to any targets at
distances as great
as 10 feet
III
7-8
Movement,
complexity,
distance viewing
Able to visually detect and attend
to objects/visual targets that do
not move or are not made of
shiny materials within 18-24
inches
Occasionally able
to detect and attend
to visual targets
beyond 2 feet
Not able to detect
or attend to nonmoving targets
beyond 2 feet
III
7-8
Movement,
complexity
No attention to
faces
III
7-8
Complexity,
novelty
Able to visually locate and/or
fixate on certain targets at
distances as great as 10 feet away
especially with targets that produce
movement
Attention at this distance may be
dependent upon the degree of
complexity of the environment
Able to detect
Movement not
targets that do not
required for
attention at near have movement,
reflective, shiny
properties
Smiles
at/regards
familiar and new
faces *
Eye to eye contact
with most faces
and discriminates
new from known
people
Glances at and/or eye to eye
contact with familiar and new
faces
Occasionally glances
toward and/or eye
contact with familiar
faces
May enjoy
regarding self in
mirror *
Consistent eye to
eye contact with
self in mirror
Consistently glances and/or looks
directly at mirror image even
though eye to eye contact may not
occur
Inconsistent glances at Mirror primarily
own image in mirror
serves as a light
gazing device
III
7-8
Complexity,
novelty
Most high
contrast colors
and/or familiar
patterns
regarded
Able to visually
attend to materials
that have more
than 2-3 colors
and the colors
may not include
the preferred
color
Able to visually attend to/look at
objects of any bright color or
objects that have simple, multi
color patterns
Able to attend to some
simple patterns,
especially familiar
ones or those that are
highlighted with the
preferred color
Preferred color
continues to be
necessary as an
element of an
object
III
7-8
Color,
complexity,
novelty
Simple books,
picture cards, or
symbols
regarded *
Able to visually
identify elements
of age appropriate
books or other 2
dimensional
materials
Visually attends to/looks at 2
dimensional materials that have
little complexity and that include
1-2 color images
Visually attends
to/looks at a small set
of 2 dimensional
materials, not able to
generalize the
images to new
contexts
May use lightbox and
lightbox pictures to
facilitate attention to 2
dimensional details
Visually
inattentive to 2
dimensional
materials
III
7-8
Complexity,
novelty
Dr. Christine Roman - Lantzy
43
March 2010
-- Assessment --
Selection of
objects not
restricted
Demonstrates
visual curiosity
and seeks out
novel objects or
materials
Able to visually examine and/or
interact with objects of any color
and of any surface pattern even if
they are novel
Visually novel
objects recognized
and/or attended to
with a single
previous experience
Visually attends
to objects that
share elements of
familiar objects
+/-
--
III
9-10
Complexity,
novelty
CVI SCORING GUIDE, CONT’D
Statement
R
+
Phase Range
CVI
Characteristic
Only the most
complex
environments
affect visual
response
Demonstrates
visual curiosity
in complex
environments,
identifies or
attends to novel
elements within
20 feet
Demonstrates visual curiosity
in familiar and novel
environments except those
with an extreme degree of
visual and other sensory
complexity
Demonstrates visual Does not
curiosity in familiar
demonstrate
environments that have visual curiosity
low degrees of
sensory complexity
III
9-10
Complexity,
novelty
Latency resolved
Directs vision to
indicate wants or
needs
No delay in visually detecting
a target after it is presented
Rare delayed visual
response to a target
Delayed visual
response to
targets when
tired, over
stimulated
III
9-10
Latency
No color or
pattern
preferences
Demonstrates
typical abilities to
attend to colors
or patterns,
No requirement for color
highlighting or pattern
adjustment/highlighting
Some novel patterns
or symbols require
color highlighting
Color
highlighting of
salient features or
details required
III
9-10
Color
Visual attention
extends beyond
20 feet *
Able to visually
locate and/or
fixates on targets
at distances
commensurate
with peers
Able to visually locate and/or
fixate on certain targets at
distances up to and possibly
beyond 20 feet away
Able to visually locate
and/or fixate on targets
that produce movement
or are reflective at
distances of 20 feet
Able to visually
locate and/or fixate
on targets up to 10
feet away
III
9-10
Distance viewing
Able to visually locate
and/or fixate on targets
without movement 1019 feet, complexity of
environment will
continue to affect
distance
Dr. Christine Roman - Lantzy
44
March 2010
-- Assessment --
Statement
R
+
+/-
Full functional use of peripheral
Greater reliance on
visual fields, some central visual
peripheral fields, may
difficulties as related to complexity continue to use near
viewing for 2
dimensional materials
-
Phase Range
III
Demonstrates
visual field
preferences
9-10
CVI
Characteristic
Visual fields
unrestricted *
Full use of both
central and
peripheral visual
fields
Visual fields
Views books or
other 2
dimensional
materials with
simple images
Identifies salient
features of 2
dimensional
materials with no
adjustment or
adaptation
Detects or identifies pictures or
symbols in books with simple
configurations
Detects or identifies
familiar elements in
familiar 2 dimensional,
simple materials
Visually inattentive
to 2 dimensional
materials
III
9-10
Complexity
Uses vision to
imitate actions *
Repeats actions in Repeats actions in response to a
response to an
direct model
indirect,
incidental model
Repeats actions in
response to a visual +
physical Prompt model
No imitation of
visual actions
III
9-10
Complexity
Anticipates an
Demonstrates
memory of visual action or event
based on
events *
environmental
visual cues
Demonstrates recognition of a
person, place or event that has
occurred in the past
Demonstrates
recognition of a person,
place or event that
occurs in a rote routine
No demonstration of
actions or events that
occur as a rote
routine
III
9-10
Complexity,
distance viewing
Initiates social
Typical visual
social responses * contact or
demonstrates
withdrawal from
unfamiliar
individuals
Demonstrates appropriate
affective social responses to input
from adult or peer facial
expression or gestures
Demonstrates
appropriate affective
social responses with
familiar people
No reliable affective
or social responses
to peers or adults
III
9-10
Complexity
Dr. Christine Roman - Lantzy
45
March 2010
-- Assessment --
Look and
reach
completed as a
single action
Consistent.
Visually guided reach used but
Visually guided reach
visually guided
may be affected by size of target or used only when the
reach regardless of complexity of background
background
size of target
Rarely uses
visually guided
reach
III
9-10
Visual motor
CVI Scoring Guide, cont’d
Dr. Christine Roman - Lantzy
46
March 2010
-- Assessment --
ASSESSMENT OF CHILDREN WITH CVI
Ideas for a Functional Vision Evaluation Kit
·
·
·
·
·
·
·
·
·
·
·
·
·
Favorite toy brought in by parent
Items from everyday routines in solid colors-cups, spoons, toothbrushes
Cereal or other real or simulated food items (Fruit Loops, red licorice, banana)
Slinkies, solid color, plastic
Black & white toys
Reflective materials-Mylar balloons, pompoms, shakers
Mirrors
Suspended or moving objects (windsock, ball on elastic cord)
Pinwheel
Black, light absorbing background
Mini lightbox with clear, colored acrylic objects
“sets” of red and/or yellow objects to be sorted into same color containers
Lights with color cap
Dr. Christine Roman - Lantzy
47
March 2010
-- IEP & Intervention --
SECTION 3: IEP & INTERVENTION
INDIVIDUALIZED EDUCATION PROGRAM (IEP) FORMAT
CVI IEP & INTERVENTION WORKSHEET
CVI Planning Table
61
81
82
IEP DEVELOPMENT
Student Example 1: John
Student Example 2: Mary
Student Example 3: Ruby
LEVELS OF INTRUSIVENESS
LEVELS OF ENVIRONMENTAL SUPPORT IN ASSESSMENT OF CVI
SUGGESTIONS FOR INTERVENTION
CORTICAL VISUAL IMPAIRMENT: IDEAS FOR INTERVENTION
83
84
84
85
86
87
88
91
INDIVIDUALIZED EDUCATION PROGRAM (IEP) FORMAT
Student name:
Joey Smith
IEP Team Meeting Date:
Parent name:
Date of Birth:
Address:
Chronological Age:
Grade:
Phone: Home
Work
County of Residence:
Social Security No.:
School District:
School the student is
attending:
Anticipated Year of
Graduation:
School Year
IEP Implementation Date (Projected Date when Services and Programs Will Begin
Anticipated Duration of Services and Programs:
Other Information:
The LEA and parent have agreed to make the following changes to the IEP without convening an IEP meeting, as
documented by:
Date of Revisions
Dr. Christine Roman - Lantzy
Participants/Roles
48
IEP Section(s) Amended
March 2010
-- IEP & Intervention --
IEP TEAM/SIGNATURES*
The Individualized Education Program (IEP) Team makes the decisions about the student's program and placement. The
student's parent(s), the student's regular teacher and a representative from the local education agency are required members
of this team. A regular education teacher must also be included if the student participates, or may participate in, regular
education. Signature on this, IEP documents attendance, and not agreement.
NAME
Position
Signature
Parent
Parent
Special Education Teacher
Local Education Agency Rep.
Student
Vocational Technical Rep.
Community Agency Rep.
Regular Education Teacher
PROCEDURAL SAFEGUARDS NOTICE
I have received a copy of the Procedural Safeguards Notice during this school year. The Local Education Agency has
informed me whom I may contact if I need more information.
Signature:
Date:
I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST CONSIDER BEFORE
DEVELOPING THE IEP. ANY FACTORS CHECKED MUST BE ADDRESSED IN THE
IEP.
Is the Student Blind or Visually Impaired?
No
Yes - Team must provide for instruction in Braille and the use of Braille unless the IEP Team determines,
after an evaluation of the child's reading and writing skills, needs and appropriate reading and writing
media (including an evaluation of the child's future needs for instruction in Braille or the use of Braille),
that instruction in Braille or the use of Braille is not appropriate.
Is the Student Deaf or Hearing Impaired?
No
Yes - Team must consider the child's language and communication needs, opportunities for direct
communications with peers and professional-personnel in the child's language and communication mode,
academic level, and full range of needs, including opportunities for direct instruction in the child's
language and communication mode in the development of the 1EP.
•
COMMUNICATION NEEDS.
Dr. Christine Roman - Lantzy
49
March 2010
-- IEP & Intervention --
ASSISTIVE TECHNOLOGY, Devices and for Services
LIMITED ENGLISH PROFICENCY
BEHAVIORS THAT IMPEDE HIS/HER LEARNING or that of OTHERS
TRANSITION SERVICES
OTHER (Specify): The team agrees that The Education Center at The Watson Institute continues to be an
appropriate placement for Joey.
II.PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
(Include Student's Present Levels in the Area of Post-Secondary Transition, If Appropriate.)
STUDENTS PRESENT LEVELS OF ACADEMIC ACHIEVEMENT:
Joey does not participate in the general education curriculum
STUDENT'S PRESENT LEVELS OF FUNCTIONAL PERFORMANCE:
Educational and Physical History:
Joey’s mother had reported a pregnancy marked with hyperthyroidism, hypertension and
preeclampsia with a C-section in 30th week. Joey spent first 6 weeks at West Penn Neonatal Unit.
Released on oxygen and apnea monitor. He was diagnosis of Periventricular Leukomalaysia (a form of
Cerebral Palsy) with greater involvement on left side and lower extremity. He has had eye surgery for
esotropia. He presents with characteristics/visual behaviors of a child with CV' (cortical visual
impairment). He is currently receiving Baclofin and Botox. He is currently wearing bilateral AFO's,
uses a wheelchair and a walker. His current medication is Lamictal 2 times/day at home.
Joey enrolled at The Education Center at The Watson Institute on September 2, 2003. Joey currently
receives Physical and Occupational Therapy at Children's Hospital of Pittsburgh — North.
Classroom:
Upon arrival to school, Joey is happy and will play with a slinky and fidget attached to his chair while
waiting for his turn to go into the bathroom. Recently, Joey has appeared to be much happier with smiling and
laughing throughout the day.
Joey enjoys social interaction with the staff and his peers. He will initiate interaction with his peers in
the play areas by crawling over and touching them or playing in close proximity with them. In small or large
group activities, he will reach over and physically touch them by patting them on the arm. However, his
interaction with the staff tends to be more aggressive in nature as he tends to grab, pinch and bite.
Joey learns best in small groups of 2-4 students in which there is a lot structure incorporated throughout
the day. He requires an environment in which there is a limited amount of auditory and visual distractions as Joey
demonstrates only fleeting glances when presented with visual materials. He is able to sit for both large and
small group activities for up to 15 minutes. While in the classroom he makes use of his wheelchair, a classroom
chair and is frequently on the floor for play time. He transitions within the classroom and to specials using a
walker and his wheelchair.
Joey participates in a daily 45 minute goal group rotation in which we focus on his individual IEP goals.
He also participates in a large group speech and fine motor activity with our therapists once a week. In addition we
have a language group which is theme focused using songs, poems and picture props. We work on appropriate
Dr. Christine Roman - Lantzy
50
March 2010
-- IEP & Intervention --
play skills which involve a specific toy along with sharing and turn taking. We do books on tape and song charts
which focus on choice making, turn taking, requesting and fine motor skills. Joey enjoys activities using a
variety of textures, fabrics, movement and the swing. Once a week we have a kindergarten level "Weekly
Reader" and every other week we have the students involved in "share and tell" with the focus being
communication.
Social/Behavior:
Joey enjoys school and social interaction with the staff and his peers. He plays well by himself but does not do
so appropriately unless it is with one on one interaction with adult facilitation. Joey enjoys tossing
a ball back and forth, bouncing the large therapy ball, activating switch toys, parachute play, the swing
and the air mattress.
Communication:
Expressively, Joey , although non-verbal, engages in vocalization to gain attention and express emotion. To express
wants and indicate choices, Joey is able to use eye-gaze and touch — reach. He is often consistent
with this when shown preferred objects. When presented with a single or double switch with a single icon,
Joey is able to press the switch to activate the verbal message. He laughs, smiles, and visually and
physically engages in preferred activities which he has chosen. He indicates refusal through
physically pushing away, or physical aggression.
Receptively, Joey localizes to sounds around him. He turns his head toward novel sounds, and
inconsistently to his name and the directive "look." He is able to follow a few familiar one-step
directives, especially when prompted by environmental cues.
Fine Motor/Perceptual Motor/Sensory Motor:
Increased tone continues to be noted in both upper extremities but not as significant as the tone in
his lower extremities. Low tone in his trunk is noted which lead him to sit with a posterior tilt and
flexed forward chest although with prompts he is able to achieve and upright posture. Joey
presents with a right-hand dominance during manipulation skills. He demonstrates a voluntary
grasp and release of objects but uses immature patterns frequently.
At this time, Joey, while he is able to elicit a radial digital grasp (using the fingers), frequently grasp objects using
a radial palmar grasp. He is noted to demonstrate a pad to pad pincer grasp on smaller objects occasionally raking
them into his palm. He is able to release objects into containers frequently using tactile prompts of the edges of
the containers as a cues of where/when to release the object. With objects that require precision releases (shapes
into puzzles or sorters), Joey requires physical prompts to get the object into the appropriate space. He is unable to
release objects to stack them without assistant. Isolated finger pointing is noted although he consistently uses a
whole hand swiping pattern when attempting to hit a switch. When presented with markers or crayons, hand over
hand assistance is required to move them and make a mark although he only tolerates this assistance for short
periods of time. Transferring of objects at midline is noted, however minimal reaching across midline is
observed, he usually reaches with the hand that is closer. Joey is able to pull apart objects and push together
objects at midline. During all fine motor manipulation, Joey appears to use tactile input making only fleeting eye
contact.
Dr. Christine Roman - Lantzy
51
March 2010
-- IEP & Intervention --
When set up at the computer or with switch access toys, Joey is able to activate these via a switch however this
appears to be random in nature. Computer programs used are cause/effect with bright colors and music
associated with them to attract his attention.
Joey presents with defensive reactions to touch, some movements and textures. He continues to improve in his
ability to tolerate textures and movements. A decrease in resistant is noted with activities that provide movementsitting on the air mattress or therapy ball. Deep pressure or a firm touch helps with decreasing his defensive
reactions to touch. At times, Joey becomes over aroused or over stimulated, deep pressure and a quite
environment assists him in modulating himself.
Joey continues to use his hands or mouth to tactilely explore objects rather than visually attend to many objects.
He appears to briefly attend and track objects presented in front of him. Joey is able to track bubbles and pop
them when they are presented in midline or slightly off midline. At this time he does not consistent regard faces
of the staff and inconsistently appears to regard photos or line drawings. With an increased clutter, a decrease in
Joey's visual regard in noted. Increased skill is noted when objects are presented with high contrast background
and extraneous objects/items are kept to a minimum.
Visually, Joey continues to demonstrate characteristics consistent with cortical visual impairment (CVO. He has
a preference for objects with red and/or yellow and is able to visually attend to objects with 2-3 colors. Movement
continues to be important factor when facilitating visual attention. Reflective materials also produce a movement
effect and Joey does visually attend to such items. Materials are still most effectively alerted to when presented in
his visual fields, but he has demonstrated the ability to visually attend more frequently to materials presented at
midline. The area of visual complexity continues to improve, but adaptations still need to be made for Joey.
Highly complex/patterned objects should not be used at this stage.
Gross Motor/Adaptive Physical Education:
Joey is making great progress with transfers and ambulation. He ambulates with a forward rollator walker
wearing bilateral AFO's for distances of 75 feet with mod assist to control the speed and direction of the walker.
At this time he needs constant assist to manage the walker. Joey is learning to walk up to his wheelchair and
classroom chair and perform a stand pivot transfer into his seat. He generally needs min to occasional mod assist
with this. Transfers from sit to stand are performed with only min assist. Joey will statically stand at his walker for
1-2 minutes with supervision as long as his attention is engaged. He has been introduced to stair climbing but still
needs primarily max, to emerging mod, assist with stairs.
Joey is able to roll and scoot on his belly on the floor. He is able to transition to sitting without help. He prefers
a W-sit position and can hold it independently. Joey has hamstring contractures of 60 degrees on the right and
almost 90 degrees on the left. He cannot long sit because of these. He is able to transition into quadruped with
verbal prompting and will do so in transition from floor to stand at his walker. Once in quad, he pulls to tall
kneel at the walker and continues to a standing position, popping up on both feet at the same time. He does this
transition with minimal contact assist and mod assist to stabilize the walker from rolling forward. In standing,
his position is windswept with knees pointing to the right. He tolerates stretching with relaxation techniques
well.
Dr. Christine Roman - Lantzy
52
March 2010
-- IEP & Intervention --
Joey has a new manual wheelchair purchased through Klingensmiths. He received it in November 2006. He wears
bilateral SMO/AFO combination braces received from DeLaTorre Orthotics in Spring 2005. In the
classroom he sits in a Rifton chair with armrests and a seat belt. He occasionally uses a mobile prone stander in
his classroom for more prolonged standing and weight bearing, however, as his active standing and walking is
improving he is spending more time using his walker and table supports to stand and less time in the more passive
standard. Joey is also self assisting with toileting as he transfers to the toilet with moderate assist and can stand
holding a grab bar so his helper can undress and dress him for wilding. Joey occasionally rides an adaptive
tricycle but has not learned how to propel the pedals yet.
During gym class, Joey demonstrates gross motor skills given demonstration, verbal prompts, and physical assistance
to complete tasks. Given verbal prompts and physical assistance he can throw, catch, and kick various sports
balls. He can participate in games that involve striking an object given physical assistance. Joey can pick up and
hold small objects (balls, bean bags, etc.,) and release to a short distance. Given physical support Joey will
ambulate short distances. Given verbal cues and physical assistance he will maneuver a jet mobile (prone
position) short distances in the gym area. Joey is cooperative with one on one instruction and enjoys a variety of
activities.
Activities of Daily Living:
Joey continues to be dependent with activities of daily living skills. He requires total assistance to dress his lower
body and is helping but still requires at least moderate assistance for pulling down his shirt once it is pulled
over his head. Physical prompts are required to put on and take off his coat. When given time and cues, he
is able to pull off his coat when only one arm is left in. During toileting, Joey requires moderate assistance to
transfer from his chair to the toilet. With prompts, he will stand up and hold on to the bar in front of him to
maintain a standing position so that his pants and diaper can be manipulated. Occasional prompts are required so that
Joey maintains a standing position during this activity. He is then able to pivot again with moderate assistance to
sit on the adaptive toilet seat ( a commode chair place over the toilet seat). He is placed on an adaptive toilet seat
once a day but has had little success up to date.
Joey continues to require assistant to eat during meals/snack. He is able to finger feed himself independently
following set up. Prompts are required to prevent him from throwing or pushing his plate off his wheelchair tray.
Assistance is required to use utensils. Once the utensil is loaded he will bring it to his mouth. At times, Joey is
able to maintain a grasp on silverware (fork or spoon) while at others he requires use of a universal cuff to maintain
a grasp. He uses a straw to drink from a cup or container but will dump an open cup if unsupervised. Frequent
verbal and physical prompts are required for Joey to feed himself and continue eating.
Dr. Christine Roman - Lantzy
53
March 2010
-- IEP & Intervention --
HOW THE STUDENT'S DISABILITY AFFECTS INVOLVEMENT AND. PROGRESS IN GENERAL
EDUCATION CURRICULUM:
Strengths:
·
Developing motor skills
·
Enjoys music and listening to stories
·
Interested in peers and will initiate social contact with them
·
Emerging self helps skills
·
Developing sense of humor
·
Curious about his environment.
Academic. Developmental. Functional Needs Related To Child's Disability:
·
To develop a functional communication system.
·
To improve receptive and expressive language.
·
To improve large motor mobility and strength.
·
To improve fine motor skills.
·
To further develop independence in activities of daily living.
·
To improve visual attention.
·
To improve sensory/movement integration.
·
To improve functional transfers and mobility.
·
The team working with what Joey needs to be aware of possible seizure activity and the nurse and his
parents are to be called immediately.
Effect on Involvement and Progress In General Education Curriculum
·
Due to Joey’s level of functioning, he experiences difficulty participating in the general curriculum. He
requires modifications to all curriculum areas including those addressing functional everyday routines.
II. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS
STUDENT PARTICIPATION — STATE ASSESSMENTS
Dr. Christine Roman - Lantzy
54
March 2010
-- IEP & Intervention --
This section applies to a student participating in the Pennsylvania System of State Assessment
(PSSA) or Pennsylvania Alternate System of Assessment (PASA)
Student will participate in the PSSA without accommodations.
OR
Student will participate in the PSSA with the following appropriate accommodations that are
necessary to measure his/her academic achievement and functional performance.
Reading (Grades 3-8, and 11):
Math (Grades 3-8, and 11):
Writing Grades 5, 8, and 11):
OR
Student will participate in the PASA He will take the 3rd grade PASA in the spring of
2006. He will take the 4th grade PASA in the spring of 2007.
Choose how the student's performance on the PASA will be documented
Videotape (which will be kept confidential as all other school records).
Written narrative (which will be kept confidential as all other school records).
Explain why the child cannot participate in the PSSA: Due to child's level of functioning.
Explain why the PASA is appropriate: PASA is appropriate due to complex learning needs
STUDENT PARTICIPATION — LOCAL ASSESSMENTS
Student will participate in Local assessments without accommodations.
OR
Student will participate in Local assessments with the following accommodations:
OR
Dr. Christine Roman - Lantzy
55
March 2010
-- IEP & Intervention --
The student will take an alternate local assessment.
Explain why the child cannot participate in the regular assessment:
Due to child’s level of functioning.
Explain why the alternate assessment is appropriate.
Assessment of educational progress will be made through the use of other standardized tests, criterion referenced
tests and classroom observation.
STUDENT'S TRANSITION SERVICES
Not appropriate due to student's age.
DESIRED POST-SCHOOL OUTCOMES: Define and project the desired post-secondary outcomes as
identified by the student, parent and IEP team in the following areas. State how each transition activity/service
needed to assist the student in reaching goals will be provided. Indicate whether an IEP goal will be written.
Post-Secondary Education and Training:
Employment Outcome:
Activity/Service
Location
(Including Courses of Study)
Dr. Christine Roman - Lantzy
Frequency
Projected Beginning
Date
56
Anticipated Duration
Agency Responsible
IEP Goal
(Y/N)
March 2010
-- IEP & Intervention --
Independent Living Outcome, if appropriate:
Activity/Service
Location
Frequency
(Including Courses of Study)
Projected Beginning
Date
Anticipated Duration
Agency Responsible
IEP Goal
(Y/N)
III. GOALS AND OBJECTIVES including academic and functional goals:
IV. (Use as many copies of this page as needed to plan appropriately. Specially designed instructions may be listed with
each goal/objective and/or listed in Section VI).
Goal 1: Improve ability to make a request on a vocal output device or communication board, from inconsistent to
consistent responses with a field of 2 pictures or real objects, 3 out of 4 opportunities; 5 out of 6 sessions, as
indicated by twice weekly data collection (ESY 2007)
Short Term Objectives/
Benchmarks
1.
Condition: When
presented with toys or
food
Behavior: Joey will request
by accessing a buttononavocal
outputdevice or a
communicationboard,with a
choice of 2.
Dr. Christine Roman - Lantzy
Criterion/Expected
Level of
Achievement
With hand-over-hand
assistance, 3 out of 4
opportunities, for 5 out of
6 sessions.
Method of
Evaluation
observation
and data
collection
Evaluation
Schedule
Report Progress (Quarterly)
1st
2nd
3rd
4th
Twice
Weekly
57
March 2010
-- IEP & Intervention --
2.
3.
Condition: When presented
with toys or food
Behavior: Joey will request
by accessing a button on a
vocal output device or a
communicationboard,with a
choice of 2.
With physical
observation and
guidance at the elbow, data
3 out of 4 opportunities, for collection
5 out of 6 sessions.
Twice
Weekly
Condition: When
presented with toys or
food
Behavior: Joey will request
by accessing a button on a
vocal output device or a
communicationboard,with a
choice of 2.
Give verbal and gestural
prompts,3out of
4opportunities, for 5 out of
6 sessions.
Twice
Weekly
observation and
data
collection
.
4.
5.
Condition: When
presented with toys or
food
Behavior: Joey will request
by accessing a button on a vocal
output device or a
communicationboard,with a
choice of 2.
Given gestural
prompts, 3 out of4
opportunities, for 5
out of 6 sessions.
Specially Designed Instructions
Modifications and
Location
SDI
Use simple pictures/real
objects that are motivating
to Joey.
Dr. Christine Roman - Lantzy
Twice
Weekly
-
-
.
Condition: When presented Independently, 3 out of 4
with toys or food
opportunities, for 5 out of
Behavior: Joey will request
6 sessions.
by accessing a buttononavocal
outputdevice or a
communicationboard,with a
choice of 2.
Encourage Joey to
follow the directive to
"look" at the pictures
prior to selection, with
pictures spaced far
enough apart for accurate
selection.
observation and
data
collection
observation and Twice
data
Weekly
collection
Frequency
Projected Beginning
Date
Anticipated
Duration
Twice weekly
3/9/06
3/9/07
The Education Center @ Twice weekly
3/9/06
3/9/07
The Watson Institute
58
March 2010
-- IEP & Intervention --
Motivators may include
food items, CD's for
music, and novel toys.
Allow Joey to use touchreach of objects if he
does not respond to
selection of pictures,
then work to progress to
picture selection.
Use a 2 button device, or
2 pictures on a
communication board.
Give direction, then be
quiet and wait for
response. No talking
while Joey is making
visual selection.
Twice weekly
3/9/06
3/9/07
Twice weekly
3/9/06
3/9/07
Twice weekly
3/9/06
3/9/07
Twice weekly
3/9/06
3/9/07
Goal 2: Joey will improve walking skills from ambulating 75 feet using a walker with moderate assistance to
control the walker to ambulating 150 feet using a walker with supervision and verbal prompts, for 3 out of 4
opportunities, with data collected twice weekly Goals will be measured by observation and data collection and
progress will be reported quarterly
Short Term Objectives/
Benchmarks
1.
Condition: When
utilizing a walker.
Behavior: Joey will walk
100 feet.
2.
Condition: When
utilizing a walker.
Behavior: Joey will walk
150 feet.
3.
Condition: When
utilizing a walker.
Behavior: Joey will walk
150 feet.
Dr. Christine Roman - Lantzy
Criterion/Expected
Level of
Achievement
Method of
Evaluation
Evaluation
Schedule
With moderate
assistance to control
the walker, for 3 out
of 4 opportunities.
observation
and data
collection
Twice
Weekly
With moderate
assistance to control
the walker, for 3 out
of 4 opportunities.
observation
and data
collection
Twice
Weekly
With minimal
assistance to control
the walker, for 3 out
of 4 opportunities
observation
and data
collection
Twice
Weekly
Report Progress (Quarterly)
1st
2nd
3rd
4th
.
59
March 2010
-- IEP & Intervention --
4.
Condition: When
utilizing a walker.
Behavior: Joey will walk
150 feet.
5.
Condition: When
utilizing a walker.
With brief,
occasional physical
prompts to control
the walker, for 3 out
of 4 opportunities.
observation
and data
collection
With supervision and
verbal prompts, for 3
out of 4opportunities
observation
and data
collection
Twice
Weekly
.
Twice
Weekly
Behavior: Joey will walk
150 feet.
Specially Designed Instructions
Modifications and SDI
Location
Provide opportunities for
daily ambulation.
Provide opportunities to
practice transfers in and
out of a variety of chairs.
Provide opportunities for
a daily standing at
supports.
Utilize visual strategies
— landmark with visual
adaptation.
Frequency
Projected Beginning Date
Anticipated Duration
Daily
3/9/06
3/9/07
Daily
3/9/06
3/9/07
Daily
3/9/06
3/9/07
Daily
3/9/06
3/9/07
The Education Center @
The Watson Institute
V. SPECIAL EDUCATION/RELATED SERVICES/SUPPLEMENTARY AIDS AN
SERVICES/PROGRAM MODIFICATIONS:
A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION:
(Specially designed instruction may, be listed with each goal/objectives
Modifications and SDI
Dr. Christine Roman - Lantzy
Location
60
Frequency
Projected
Beginning
Date
Anticipated
Duration
March 2010
-- IEP & Intervention --
General SDI's
Promote the generalization of skills across all
environments.
Use a variety of visual and auditory stimuli to maintain
interest and motivation
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Provide an integrated therapy program within the
classroom to promote skill acquisition.
Daily
3/9/06
3/8/07
Use communication system across school
environments.
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Family support and opportunities to attend support
group meetings will be offered.
Daily
3/9/06
3/8/07
Provide visual strategies consistent with cortical visual
impairment needs.
Daily
3/9/06
3/8/07
Use materials that have preferred colors within them or
outlined in red and yellow.
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Allow adequate response time from with either a verbal
request or a request to have him look at something.
Daily
3/9/06
3/8/07
Initially use objects or pair objects with photos or line
drawings to enhance understanding.
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Provide Joey with opportunities to reach and grasp a
variety of different textured items.
Daily
3/9/06
3/8/07
Provide with opportunities to interact with cause/effect
programs on the computer
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Utilize a variety of reinforcers.
Utilize multi-sensory approach.
Provide sufficient response time.
Incorporate movement or use reflective materials which
have a movement component "built in."
Present materials in Joey’s peripheral fields initially and
theft work toward midline as possible. His right field
seems preferred
Monitor classroom environment. Over stimulation may
decrease ability to visually attend
The Education Center
@ The Watson
Institute
Visual complexity needs to be monitored and materials,
backgrounds kept simple, avoid visually busy materials,
toys, and backgrounds
When presenting materials/tasks keep verbalizations
and directions to a minimum. If your voice completes
with the visual information being presented, Joey may
only listen and not look
Continue to work on bilateral/ bimanual skills
Personal Care Assistant Services:
Dr. Christine Roman - Lantzy
61
March 2010
-- IEP & Intervention --
Activities of daily living such as eating, grooming,
toileting, etc.
Assisting, monitoring, and guiding the child/student to
pay attention,
participate In activities, and complete tasks
Assisting the student to use any adaptive equipment.
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Assisting the student to ambulate, position, and transfer.
Range of motion and other exercises
Monitoring the incidence and prevalence of designated
health problems or medication conditions, i.e., seizure
precautions or extreme lethargy.
Intervening to redirect inappropriate behavior.
B. RELATED SERVICES: List the services that the student needs in order to benefit from or access
his/her special education program:
Projected
Anticipated
Beginning Date
Duration
Daily
3/9/06
3/8/07
Occupational Therapy
150-300 min/month
3/9/06
3/8/07
Physical Therapy
150-300 min/month
3/9/06
3/8/07
150-300 min/month
3/9/06
3/8/07
15 minutes consultative
3/9/06
3/8/07
Daily
3/9/06
3/8/07
30 min/ week
3/9/06
3/8/07
3/9/06
3/8/07
3/9/06
3/8/07
Service
Location
Frequency
Transportation
Speech and Language Pathology Therapy
Social Work Services
The Education Center @
The Watson Institute
Personal Care Assistance
Adaptive Physical Education
As needed medication
administration/ seizure
management
School Heath Services
Consult
Vision
Delivery of physical therapy related services is contingent upon current physician prescription
Dr. Christine Roman - Lantzy
62
March 2010
-- IEP & Intervention --
C.SUPPORTS FOR SCHOOL PERSONNEL RELATED TO STUDENT’S NEEDS:
Frequency
Projected
Beginning
Date
Anticipated
Duration
Weekly
3/9/06
3/8/07
Physical Therapy
Weekly
3/9/06
3/8/07
Speech and Language Pathology Therapy
Weekly
3/9/06
3/8/07
Social Work Services
Monthly
3/9/06
3/8/07
Daily
3/9/06
3/8/07
Adaptive Physical Education
Weekly
3/9/06
3/8/07
School Heath Services
Monthly
3/9/06
3/8/07
Vision
Monthly
3/9/06
3/8/07
Service
Location
Occupational Therapy
Personal Care Assistance
C. EXTENDED SCHOOL YEAR: The IEP Team has considered and discussed ESY services, and
determined that (indicate whether student is eligible or not eligible for ESY and the basis for the
determination):
Student is NOT eligible for ESY based on:
OR
Student IS eligible for ESY based on other factors. He requires ongoing programming to
continue to develop and tome his IEP goals and objectives
ESY 2007 was discussed. Goals were identified for data to be collected. These goals are:
Goal 1 (communication), Goal 3 (functional mobility) and Goal 4 (increase independent
feeding skills). Baseline data will be collected in June 2006.
If the IEP Team has determined ESY is necessary for the provision of FAPE, complete the follow. The
Annual Goals and, when appropriate, Short Term Objectives form his IEP that are to be address in the
child’s ESY program are:
ESY Service/SDI
The Education Center ESY Program
Dr. Christine Roman - Lantzy
Location
Frequency
Monday – Friday
9:00-1:00
The Watson Institute
63
Projected
Beginning Date
7/5/06
Anticipated
Duration
7/26/06
March 2010
-- IEP & Intervention --
VI. EDUCATIONAL PLACEMENT
A. EDUCATIONAL PLACEMENT: (Types of Service, Type of Support, i.e., Full-time learning
support)
Type of Service: Full Time
Type of Support: Life Skills Support
Explanation of the extent, if any, to which the child will not participate with non-disabled children in
the regular class:
Joey requires a highly structured environment 100% of the time to best meet his educational needs at
this time. This more restrictive setting will be monitored by the team on an ongoing basis.
VII.
PENN DATA – LEAST RESTRICTIVE ENVIRONMENT (must select and complete either A or B
as appropriate).
A. For students being educated In regular buildings with non-disabled peers, indicate the
percentage of time the student receives special education outside of the regular
education classroom (see examples below for guidance on how to calculate).
Less the 21% outside of the regular education classroom.
21-60% outside of the regular education classroom.
61% or more outside of the regular education classroom.
Name of School Building:
B. For all other students being educated outside regular school buildings, indicate the
location where services are delivered (APS, PRRI, etc.):
Dr. Christine Roman - Lantzy
64
March 2010
-- IEP & Intervention --
Approved Private School -- The Education Center at The Watson Institute, 301
Camp Meeting Road, Sewickley, PA 15143
How to Calculate Penn Data LRE Percentages
Total # hours the
student receives
special education
services per week
Total # hours the
student receives
special education
services in regular
classroom
Total # of hours
outside of regular
education classroom.
Total # hours in school
per week
# hours outside /
# hours in school
x 100 = %
29
0
29
29
29/29= 100%
CVI IEP & INTERVENTION WORKSHEET
This worksheet may be useful for IEP planning and for creating a "template" of CVI considerations
that can be applied to the child/student's daily routines.
Child/student name:
Date:
IFSP/IEP planning members:
CVI Range score:
CVI Phase:
Dr. Christine Roman - Lantzy
65
March 2010
-- IEP & Intervention --
Resolved CVI characteristics (check):
Unresolved CVI characteristics (check):
color
color
movement
movement
latency
latency
visual fields
visual fields
complexity
complexity
object
object
array
array
sensory
sensory
light gazing
light gazing
distance viewing
distance viewing
visual novelty
visual novelty
visual motor
visual motor
CVI Planning Table
Example:
Daily Schedule/ Time and
Activity
CVI Characteristics
10 AM, fine motor with OT or classroom
personnel
color (red), movement, & complexity of
object/array/ sensory environment
CVI adaptations for this
activity
· Select fine motor materials that are
·
·
·
primarily red & highlighted with red
mylar
Use black felt 12 inch
high tri-fold board
Explain task, quiet while student
attempts task, praise after student
finishes task
CVI PLANNING TABLE
Daily Schedule/ Time and
Activity
Dr. Christine Roman - Lantzy
CVI Characteristics
66
CVI adaptations for this
activity
March 2010
-- IEP & Intervention --
Activities not considered compatible for CVI interventions:
Example:
Classroom birthday parties are primarily social events planned by student's parents and therefore not
easily adapted for this student's CVI needs.
1.
2.
3.
4.
IEP DEVELOPMENT
Referral
· Why doesn't this student use vision?
Screening
· Does this student have a CVI profile?
Assessment
Dr. Christine Roman - Lantzy
67
March 2010
-- IEP & Intervention --
·
·
Does this student demonstrate the CVI characteristics?
If CVI characteristics are present—AND— team agrees that intervention is appropriate, an IEP
is developed
Long-range goals = CVI Phases
· Phase I
0 to .4 on the Scale
"building visual attention"
· Phase II
4+ to 7 on the Scale
"embedding vision into function"
· Phase III
7+ to 10 on the Scale
"resolution of CVI characteristics"
·
· Short term objectives=CVI characteristics that are scored:
·
.75
·
.50
·
.25
·
0
·
All unresolved characteristics require intervention
STUDENT EXAMPLE 1: JOHN
John scores 3 on CVI Scale
2 characteristics include:
· Score of .25 in color
· Score of 0 in movement
Long-range goal:
John will increase use of vision in functional academics, self-help and leisure routines.
Short-term objective:
John will visually attend (localize or fixate) to the red reflective cup as it is brought to his mouth
during snack time with visual attention to the cup increasing in both frequency and duration.
For the characteristic of color:
Dr. Christine Roman - Lantzy
68
March 2010
-- IEP & Intervention --
John will visually attend to fine motor activities that are red or adapted with single-color, red
materials.
For the characteristic of movement:
John will visually attend to leisure-time activities that are red and have movement properties
and/or red reflective surfaces.
STUDENT EXAMPLE 2: MARY
Mary scores 6 on the CVI scale
2 characteristics include:
· score of .5 in complexity
· score of .75 in visual fields
Long-range goal:
Mary will integrate vision with gross and fine motor movements.
Short-term objectives:
For the characteristic of complexity:
Mary will look & reach for a single color object presented in an array of no more than 3 objects
that are placed on a high contrast, light absorbing background. (with increasing independence,
decreasing prompt..)
For the characteristic of visual fields:
Mary will look & reach in her left lower visual field to activate switches, and to obtain objects
for fine motor or self-help routines.
STUDENT EXAMPLE 3: RUBY
Ruby scores 9 on the CVI scale
2 CVI characteristics include:
Score of .75 in distance viewing
Score of .75 in visual motor
Long-range goal:
Ruby will refine visual skills in near and distance activities
Short-term objectives:
For the characteristic of distance viewing:
Ruby will visually locate and identify functional indoor landmarks at distances up to 20 feet and
will travel with decreasing amounts of assistance to the landmark destinations.
For the characteristic of visual motor:
Ruby will coordinate movements of looking and reaching by maintaining visual attention while
reaching for targets that decrease in size or, that are presented in backgrounds of increasing
complexity.
Dr. Christine Roman - Lantzy
69
March 2010
-- IEP & Intervention --
LEVELS OF INTRUSIVENESS
Most intrusive to least intrusive
1.
Black Light
Dark Room
· movement
· without movement
2.
Light in a Dark Room
· movement
· without movement
White
Yellow
Red
3.
Light in a Lighted Room
· movement
· without movement
4.
Reflective Material
· movement
· without movement
5.
Fluorescent Materials
· movement
· without movement
6.
High Contrast Colors
· movement
· without movement
7.
Low Contrast Colors
· movement
· without movement
Dr. Christine Roman - Lantzy
Blue
Green
70
March 2010
-- IEP & Intervention --
LEVELS OF ENVIRONMENTAL SUPPORT IN ASSESSMENT OF CVI
Level I-Greatest Support-Student Visually Attends:
1. only to familiar objects
2. when there are no sound distracters
3. when there are no visual distracters
4. when the room light is low
Level II-Moderate Support-Student Visually Attends:
1. to a variety of objects that share features of color or pattern with the "familiar" objects
2. when familiar or low intensity auditory inputs compete
3. on increased pattern/object beyond 3-4 feet
4. does not require adjustment of room light and is not overly attentive to primary sources of room
light
SUGGESTIONS FOR INTERVENTION
Lightbox Activities
Zip-lock freezer bags can be used on the lightbox to enhance looking behavior and to encourage visual motor
progress. Consider double bagging to avoid leakage.
·
·
·
·
·
Fill the bag with clear hair gel then add several drops of food coloring.„ The color gets mixed as
the child presses on the gel surface. The color, light and movement properties will attract the
child's visual attention. Begin with a single color only.
Fill the bag with warm water and release transparent, colored beads into the water. The slightest
touch will create movement without auditory competition. Again, color, light and movement
properties should attract the child's visual attention. Even the slightest touch will create
movement of the beads facilitating independent interaction with the materials. Begin with single
color beads.
Fill the bag with warm water and add drops of food coloring.
Fill the bag with water or gel and add bright, single color (later, 2 colors) shapes cut from acetate
sheets. Shape punches from craft stores work very well.
Look for colored transparent objects that can be used in the zip lock bags from dollar stores.
Select objects that have rounded edges. Bingo chips and small plastic balls work well.
Additional Lightbox Activities
·
Transparent containers used with transparent, colored objects can be used on the lightbox for
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-- IEP & Intervention --
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visual-motor, placing, and sorting activities. For sorting, cover the lid of the container with black
paper, leaving only the shape opening uncovered. The light from the lightbox will shine through
the opening creating a high contrast target for placement of the shape.
A black grid and color pegs (APH product #1-08665-00) can facilitate visual motor, placement
& sorting/.matching activities. Remember to consider visual field function when presenting the
activity and match color to the child's color preference.
APH Familiar Object Pictures (APH #108666-00) are very helpful for recognition of 2
dimensional information. These colored translucent pairs of pictures depict 15 common
household objects that are very simple in form and color.
APH Plexiglas Spinner & Patterns (APH#1-08664-0) can be placed on the lightbox and can be
easily activated by touch and it does not have potentially distracting auditory input. Color may be
added to the spinners to make them more CVI appropriate.
Beginning puzzles can be made from black foam board and translucent color shapes (APH#108663-00). Start with single shape puzzles, favorite color shapes.
Include other translucent, single color, non auditory objects for lightbox play (Slinky...)
Reflective/Movement Materials
Materials with reflective properties can be useful in stimulating peripheral vision and therefore, the
desire to direct visual attention toward the moving target. The following materials may be useful in
motivating an individual to look.
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·
·
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Any single color mylar pompom as long as the pompom matches the child's preferred color.
Gold sometimes works for individuals who prefer the color yellow.
Mylar balloons with little or no added picture or pattern. Patterns should be restricted to favorite
color and should have no more than 1 to 2 colors. Balloons that are tied to a floor weight also
provide an opportunity for the individual to reach/bat at the object.
Shakers or rattles that have little or no auditory input. Sound in these objects may be acceptable
if your instructional goal is for the individual to look & reach, not to continuously regard the
object in hand. Dollar stores are filled with these items.
Reflective "cuffs” can be slipped onto utensils to encourage the individual to visually attend to
the spoon/fork throughout mealtime. Again, match the color and/or pattern to the individual's
favorite.
Other movement materials (non-reflective) include: color pompoms, wind socks, lava lamps, fish
tanks, specially selected videos.
Two Dimensional Materials
Moving from objects to pictures requires careful planning. The following suggestions provide a
framework for this progression.
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Match familiar objects to same pictures and present in pairs.
Simple color, translucent pictures, like the APH Familiar Object Pictures, presented on the
lightbox can teach picture discrimination, picture recognition, and picture identification.
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-- IEP & Intervention --
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Create simple picture books with only one picture per double page presented. Images should be
selected based on color preference, familiarity of subject, and simplicity.
Create or select books that have pictures based on a theme, for example, “foods I eat”, “things I
wear”, “toys I like”. Avoid pictures with internal detail and do not use photographs.
Commercial books that are very simple are available. Maizie books, Bugs in A Box books are
two examples.
When photographs are presented, begin with faces, and only later present pictures of familiar
people against backgrounds.
Additional photo books can be designed with themes in mind, for example, photos of balls, or,
photos of shoes...
Recognition of self in photographs generally occurs around the same time that an individual is
able to recognize themselves in a mirror image. (generally, after 7-8 on CVI scale)
CORTICAL VISUAL IMPAIRMENT: IDEAS FOR INTERVENTION
The Mysterious Normal Eye Exam
- history of associated CVI systemic conditions - asphyxia, hypoxia, neonatal depression, grade
III or IV IVH, structural differences in the brain, congenital infection
- history of associated CVI conditions - optic nerve atrophy, optic nerve hypoplasia, optic nerve
dysplasia
- don't rule out ROP or other retinal abnormalities
- ask parents
Latency
- allow quiet response time "beyond reasonable" in the early stages of intervention, expect latency
to decrease within each session & over multiple sessions
- latency will vary according to time of day, state of alertness, degree of "stress" and neurologic
stability
- decreasing latency = increased visual behavior; it is one of the greatest indicators that your
interventions are working
Movement
- movement stimulates the "where" system and gets the visual system activated
- can be used for incidental practice in visual attention during "down times" . . . wind socks,
reflective pompoms, adapted mobiles, movement outside a window can all provide extra practice
in visual attention
- remember, movement without sound is generally easier
Visual Complexity
- one color/pattern objects at first . . . this may require turning
- toys so that the "busy" areas face away from the child
- two colors can be introduced slowly but have the favorite
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-- IEP & Intervention --
-
color dominate
add color/pattern as the child increases amount of attention and decreases latency, but try to build
on the favorite color/pattern slowly
complexity can also be reduced by covering portions of toys so that only the favorite color or
pattern are presented to the child for viewing
remember that the background is also part of visual complexity - try to select solid color, visually
neutral backgrounds and monitor glare carefully
complexity also considers distance viewing (too much background to sort out) and multisensory
input toys
Visual Novelty
- novelty issues will resolve over time as over-all visual behavior increases
- early on it is important to limit the number of objects selected for visual/near tasks; this is an
investment that will pay off later - create a box of "things she/he likes to look at" and limit the
introduction of new things presented
- as the child begins to demonstrate increased visual curiosity in familiar environments, it's time to
introduce slightly novel objects
- although object redundancy may seem boring to non-CVI children, it may seem like "coming
home" to children with CVI
Light Gazing Behaviors
- light is "the best and the worst of times" for children with CVI - use light to create more
appropriate visual attention lightboxes with toys to activate presented in a dimly lit room will
redirect the less purposeful desire to gaze at ceiling lights or window light
- select lighted electronic toys with great caution - they are frequently overstimulating and require
simultaneous multisensory processing; remember, less is often more some children with CVI use
their vision most consistently at night or when the room lights are very low. . . fewer
environmental items to attempt to locate or sort out . . . a
- gooseneck lamp directed to a one/two color task presented on a solid color background often
works great; the light serves as an attention enhancer
- photophobia is rare in children with CVI, but it can occur
Visual Field & Visual Motor Responses
- almost all children with CVI have visual field differences; in
- assessment, it's very important to determine whether the
- difference is symmetric or asymmetric - often it is mixed associated head movements include
eccentric viewing, and lateral head turning if one dominates "where" an object is while the other
dominates "what" an object is
- midline is rarely the preferred object presentation location lack of visual motor match may be
related to visual field function, multisensory processing, latency, or all of the above
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-- IEP & Intervention --
REMEMBER:
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not all children with neurologic complications "act blind"
CVI generally improves or gets worse but it does not remain static
parents know their children
the greatest window for change occurs in the first three years of life - this time provides the best
opportunity for permanent change in visual behavior
find medical specialists who buy into beliefs about CVI - if you can't find them, begin to educate
physicians who will assist you
the treatment for CVI is educational - we are the treatment specialists in the rehabilitation of CVI
Dr. Christine Roman - Lantzy
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March 2010
-- Resolution Charts --
SECTION 4: RESOLUTION CHARTS
CVI RESOLUTION CHART
CVI / ORIENTATION AND MOBILITY RESOLUTION CHART
95
96
CVI RESOLUTION CHART
Use the following chart to help develop areas of needs for development of IEP goals and objectives.
Phase I
Phase II
Phase III
Building Visual Behavior
Level I Environmental
Considerations
Integrating Vision with Function
Level II Environmental
Considerations
CVI
Characteristics
Range 1-2 (0) Range 3-4
(.25)
Color
Objects viewed are
generally single
color
Movement
Resolution of CVI Characteristics
Level III Environmental
Considerations
Range 5-6
(.50)
Range 7-8
(.75)
Range 9-10
(1)
Has “favorite”
color
Objects may have
2-3 colors
More colors,
familiar patterns
regarded
No color or pattern
preferences
Objects viewed
generally have
movement/
reflective
properties
More consistent
localization, brief
fixations on
movement and
reflective materials
Movement
continues to be an
important factor to
initiate visual
attention
Movement not
required for
attention at near
Typical responses
to moving targets
Latency
Prolonged periods
of visual latency
Latency slightly
decreases after
periods of
consistent viewing
Latency present
only when student
is tired, stressed, or
overstimulated
Latency rarely
present
Latency resolved
Visual Fields
Distinct field
dependency
Shows visual field
preferences
Field preferences
decreasing with
familiar inputs
May alternate use
of right and left
fields
Visual fields
unrestricted
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March 2010
-- Resolution Charts --
Complexity
Responds only in
strictly controlled
environments.
Visually fixates
when environment
is controlled
Generally, no
regard of the
human face
Student tolerates
low levels of
familiar
background noise.
Regards familiar
faces when voice
does not compete
Competing
auditory stimuli
tolerated during
periods of viewing
– student may now
maintain visual
attention on music
toys
Views simple
books/symbols
Only the most
complex visual
environments affect
visual response
Views books or
other 2dimensional
materials.
Typical visualsocial responses
Smiles at/regards
familiar and new
faces
Light
Gazing/nonpurposeful gaze
May localize
briefly but no
prolonged fixations
on objects or faces.
Less attracted to
lights – can be
redirected to other
targets
Light is no longer a
distracter
Overly attentive to
lights or perhaps
ceiling fans.
Phase I
Phase II
Phase III
Building Visual Behavior
Level I Environmental
Considerations
Integrating Vision with Function
Level II Environmental
Considerations
Resolution of CVI Characteristics
Level III Environmental
Considerations
CVI
Characteristics
Range 1-2 (0) Range 3-4
(.25)
Range 5-6
(.50)
Range 7-8
(.75)
Range 9-10
(1)
Distance
Viewing
Visually attends in
near space only
Occasional visual
attention on
familiar, moving or
large targets at 2-3
feet
Visual attention
extends beyond
near space, up to 46 feet
Visual attention
extends to 10 feet
with targets that
produce movement
Visual attention
extends beyond 20
feet
Blinks in response
to touch but
response may be
latent
Blink response to
touch consistently
present
Visual Reflexive
Responses
No blink in
response to touch
and/or visual threat
Demonstrates
memory or visual
events
Visual threat
response
intermittently
present
Dr. Christine Roman - Lantzy
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Visual threat
Visual reflexes
response
always present,
consistently present resolved
(both near 90%
resolved)
March 2010
-- Resolution Charts --
Visual Novelty
Only favorite or
known objects
solicit visual
attention
May tolerate novel
objects if the novel
objects share
characteristics of
familiar objects
Use of “known”
objects to initiate
looking sequence
Selection of objects Selections of
less restricted,
objects not
requires 1-2
restricted
sessions of “warm
up” time.
Visual Motor
Look and touch
occur as separate
functions
Look and touch on
smaller objects that
are familiar,
lighted, or
reflective
Visually guided
reach with familiar
objects or
“favorite” color
Look and touch
occur in rapid
sequence but not
always together
Large and/or
moving targets
Look and touch
consistently
Key:
• Draw an X through boxes that represent resolved visual behaviors
• Use highlighter to outline boxes describing current visual functioning
• Draw an "0" in boxes describing visual skills that may never resolve because of co-existing
ocular conditions
Notes:
CVI / ORIENTATION AND MOBILITY RESOLUTION CHART
Use the following chart to help develop areas of needs for development of IEP goals and objectives.
Phase I
Phase II
Phase III
Building Visual Behavior
Level I Environmental
Considerations
Integrating Vision with Function
Level II Environmental
Considerations
Resolution of CVI Characteristics
Level III Environmental
Considerations
CVI
Characteristics
Range 1-2 (0) Range 3-4
(.25)
Range 5-6
(.50)
Range 7-8
(.75)
Range 9-10
(1)
Color
Single color
environmental
features may be
attended to at near
Strong single color
preference persists
Objects or
environmental
features that have
2-3 colors may now
be attended to
within 4-6 feet
More colors, high
contrast areas may
solicit visual
attention
Safe travel not
dependent on color
cues
Movement
Targets viewed
have movement
and/or reflective
properties
Movement in the
environment may
distract from
primary target
Movement may be
needed to establish
attention on target
/destination
Movement not
required for
attention within 3-4
feet, may be
necessary beyond
Movement not
necessary for visual
attention near or
distance
May be attentive to
ceiling fans
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March 2010
-- Resolution Charts --
Latency
Prolonged periods
of visual latency
Visual Fields
Distinct field
preferences; may
use one
eye/peripheral,
other eye/central
Complexity
Visually attends
only in strictly
controlled
environments –
those without
sensory
distractions;
Generally, rote,
assisted travel
Latency slightly
decreases after
periods of
consistent viewing
Visually attends
and or fixates on
simple targets at
near (within 3 feet),
environment
controlled for
sensory distracters
Latency present
only when student
is tired, stressed, or
over stimulated
Latency rarely
present
Latency resolved
Visual field
preferences persist
Increasing use of
right and left fields
for near and
distance activities
Visual fields
unrestricted
Student may now
be able to tolerate
low levels of
familiar
background noise
while maintaining
visual attention on
familiar targets.
Competing
auditory stimuli
tolerated during
periods of viewing
Only the most
complex
environments affect
independent travel.
Student may now
travel familiar
routes using
naturally occurring,
simple landmarks /
cues
Environmental/
traffic signs may
now be useful for
independent travel
Rote or route travel
with adapted visual
cues
Light
Gazing/nonpurposeful gaze
Overly attentive to
lights
Room light may
have to be reduced
Less attracted to
lights-student can
be redirected to
other targets
Light is no longer a
source of
distraction
Phase I
Phase II
Phase III
Building Visual Behavior
Level I Environmental
Considerations
Integrating Vision with Function
Level II Environmental
Considerations
Resolution of CVI Characteristics
Level III Environmental
Considerations
CVI
Characteristics
Range 1-2 (0) Range 3-4
(.25)
Range 5-6
(.50)
Distance
Viewing
Visually attends in
near space only
Visual attention
extends beyond
near space, up to 46 feet
Dr. Christine Roman - Lantzy
Occasional visual
attention on
familiar, moving or
large targets in
simple or familiar
settings, up to 3-4
feet
Range 7-8
(.75)
Range 9-10
(1)
Visual attention
Visual attention
extends to 10 feet
extends beyond 20
with targets that
feet
produce movement.
Student
Complexity in the
Color cues,
demonstrates
environment may
movement and size memory of routes,
reduce this distance of target may factor cues or landmarks
in.
and may now be
able to travel
independently
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March 2010
-- Resolution Charts --
Visual Reflexive
Responses
No blink in
response to touch
and/or visual threat
Blinks in response
to touch but
response may be
latent
Blind response to
touch consistently
present.
Visual threat
response
consistently present
Visual threat
intermittently
present
Student may now
anticipate
approaching
obstacles
Visual Novelty
Student only
May visually attend
responds to familiar to objects or
objects
environmental
features if they
share
characteristics with
the familiar objects
Visually attends to
landmarks or cues
that are highlighted
with familiar color
or pattern
Selection of objects
or environmental /
route cues
remembered after
several sessions of
familiarization
Selection of
objects,
environments not
restricted or
specially adapted
Visual Motor
Reach, touch, look
occur as separate
functions
Visually guided
reach with familiar
materials, simple
configurations and
“favorite” color
Look and reach
occur in sequence
but not always
together
Look and reach as a
single action
Key:
• Draw an X through boxes that represent resolved visual behaviors
• Use highlighter to outline boxes describing current visual functioning
• Draw an "0" in boxes describing visual skills that may never resolve because of co-existing
ocular conditions
Notes:
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March 2010