General Suggestions to Assist Interactions with Children with Cortical Vision Impairment
by Kathleen Appleby, M.A.
Since every child is different there is no "cookbook" for any one child when it comes to developing a plan for intervention and integration of vision into his or her daily life. All aspects of the child must be taken into consideration:
• Motor • Communication • Cognition • Physical Health • Environmental • Processing.
Strategies that appear appropriate can be utilized in a "trial and error" fashion with the child. If they result in improved visual responses and over all interactions with the child repeat the strategies. Be aware of signs of improvement in the child's levels of performance so you can phase out adaptations to encourage more realistic presentations. Avoid isolated activities that do not have real life carryover whenever appropriate and possible. Encourage utilization of the strategies during daily activities so the child becomes more "functionally" visual.
SUGGESTIONS
Avoid Visual Clutter: Present objects against a plain background & widely spaced. Some children may have difficulty visually discriminating objects from the background. Some children may have to close their eyes to control over stimulation. Some children hold objects close to their eyes to fill the entire visual fields and eliminate visual distractions.
Pair the Object: Use sound, movement, color &/or a child's touch paired with the object. Some C/CVI children visually respond best to movement of objects, usually in their periphery. Use simple descriptions of "what" the object is and "where" the object is located, etc. For example, "Look at your cup. It is on the table."
Perception of Object: Encourage the child to experience the object in as many ways as possible so he/she can develop the "ness" of the object. For example, give the child opportunities to hold, peel, smell, cut and eat a banana. This will assist in the development of the perception of "banana" so the child can better understand what is seen. The child may have "piecemeal" vision and have difficulty perceiving the total "image" of objects. Utilize techniques used for a blind child by introducing new objects, encouraging tactile exploration of the entire object.
Visual Gaze: Peripheral gaze may be necessary verses a direct central gaze, i.e., the child may look at the object and then look away when reaching. It may be that the child is only able to integrate one sensory input at a time or he or she may be using peripheral vision.
Visual Preferences: Determine the child’s preference for objects by size and color. Place these objects in the location that the child most frequently looks toward while the child is in his or her most stable and comfortable position.
Environment: Be sensitive to the child's surroundings and time of day. Adapt the surroundings to reduce noise, clutter, glare, etc. For example, I place a plain sheet over the furniture when working on the floor in a child’s home. I also wear a plain light colored apron to present objects against.
Objects: Use real & familiar objects verse abstract objects, i.e., teach "attributes", "same & different" and "visual discrimination" by sorting spoons & forks vs. circles and squares, etc., when appropriate. Children with C/CVI typically have difficulty generalizing between objects, i.e., they may know their own cup but can may not know a different looking cup is also a cup. Keep the objects and placements constant initially until the concept is established then broaden the activity to include similar objects.
Levels: Take the child's motor, cognitive and communication levels into consideration and present activities adapted to these levels.
Active Learning: Engage the child in a play situation at his/her levels and encourage independent interactions to avoid passive learning. Utilize a routine/pattern of interaction and repetition. Empathize a clear beginning and end to activities. Work on a tray when possible to offer a space within which to present materials. Offer adequate time and cueing when there is a transition between activities. Use short "working" sessions.
Communication: Utilize a "calendar box", when appropriate, to offer a clear beginning and end to activities. A "calendar box", based on Dr. Van Dyke's theories, consists of small boxes placed side by side with real objects velcoed on the boxes for a tactile representation of each of the child’s daily activities, one object on each box. The teacher talks to the child about the sequence of the day as he or she looks at and feels each of the objects. Later the child looks at and feels the object before each activity and takes it off the box and puts it in the box when the activity is over and then goes to the next box to find the object representing the next activity. For example, use an empty juice box to represent snack time. Phase the objects to symbolic representations of the object when the child is able to generalize the meaning, i.e., replace the juice carton (representing snack) with a straw.