Characteristics of Cortical Visual Impairment Checklist
Children with other types of visual impairments may exhibit some of these characteristics
CHILD’S NAME_______________________________ AGE________ DATE______
RESPONDENT’S NAME & RELATION TO CHILD__________________________________
A child may be suspected of having a cortical visual loss when the extent of visual loss is unexplained by ocular abnormalities. Etiologies may include cerebral palsy, asphyxia, intracerebral hemorrhage, and meningitis.
Please check any areas below that pertain to the child.
APPEARANCE |
___ Does not look blind ___ Blank facial expression ___ Lack of visual communication skills ___ Eye movements smooth, but aimless ___ Nystagmus (rapid eye movement) rarely seen |
VISION FUNCTION |
___ Visual function varies from day to day or hour to hour ___ Limited visual attention and lacks visual curiosity ___ Aware of distant objects, but not able to identify ___ Spontaneous visual activity has short duration ___ Visual learning tiring ___ Closes eyes while listening ___ Balance improved with eyes closed ___ Look away from people and objects ___ Consistently look to either side when visual looking ___ When visually reaching looks with a slight downward gaze ___ Turns head to side when reaching, as if using peripheral fields ___ Uses touch to identify objects
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MOBILITY SKILLS |
___ Occasionally "sees" better traveling in a car ___ Difficulties with depth perception, inaccurate reach ___ Unable to estimate distances ___ Difficulties with spatial interpretation ___ Avoids obstacles, but unable to use vision for close work
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IMPROVED VISUAL PERFORMANCE |
___ When in familiar environments and when using familiar objects ___ When told "what" to look for and "where" to look ___ When objects are held close to eyes when viewing ___ When objects are widely spaced ___ When looking at one object verses a group of objects ___ When color is used to assist in identification of objects or shapes ___ When objects are against a plain background and paired with movement and sound K. Appleby's compiling information from article by: Jan, J.E., Groenveld, A., Sykanda, A.M., Hoyt, C.S. (1987) "Behavioral Characteristics of Children with Permanent Cortical Visual Impairment." Developmental Medicine & Child Neurology, 25,755-762.
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