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A multisensory approach for children with CVI

Learn about what multisensory learning looks like and why it's necessary to ensure full access to education for children with CVI.

Boy using both hands to explore different textured cards while sitting at table. He has a smile on his.

Individuals with CVI require a multisensory approach to learning. No matter how CVI manifests, there may be moments, specific situations, or vast swaths of the day where vision is not available—where individuals with CVI choose to use other senses and strategies to learn and interact with their world. 

“When you have CVI, seeing is not passive. Anything sight-related is active WORK. Relentless, grueling WORK. Tons of effort, very little payoff. It is always a big deal.”

The CVI Perspective

For many individuals with CVI, using vision is hard work, often resulting in visual fatigue, exhaustion, and stress. Visual fatigue is likely one of the most common shared experiences among individuals with CVI. 

Therefore, it’s essential to help individuals with CVI build their dynamic toolbox for access by providing multiple tools to use and figure out what works best for them. Autonomy and choice must always be the underlying principle when working with students with CVI and all children with disabilities. 

What is a multisensory approach?

A multisensory approach incorporates different sensory channels into the learning process—auditory, tactile, visual, kinesthetic (movement), olfactory (smell), and taste. 

All sensory inputs support brain development. Our brain is highly interconnected and ever-changing. With CVI, it’s not only about the possibility of visual improvement, but it’s also about the growth of sensory efficiency skills that will support learning and independence.

“[T]he brain is stunningly gifted at taking in signals and extracting information patterns… All of the hues and aromas and emotions and sensations in your life are encoded in trillions of signals zipping in the darkness inside your skill… Whatever information the brain is fed, it will learn to adjust to it and extract what it can… [a]s long as the data reflects something important about the outside world.” —David Eagleman, Livewired: The Inside Story of the Ever-Changing Brain (2020)

One of the neurodiversities for many individuals with CVI is the need to process one sensory input at a time. For example, an individual with CVI will listen but not use vision when someone is talking or when reaching for something vision is only used after touching the item. 

“I realized that if I have to use all of my senses at the exact same time, one will have to back off. With CVI, it is always ALWAYS the vision.”

Dagbjört, adult with CVI

As always, comprehensive CVI assessments that include a Learning Media Assessment (LMA) will help determine how a child with CVI uses their sensory channels for learning. It’s important to know the child’s unique vision and what visual access looks like within a multisensory approach. To be clear: a multisensory approach does not necessarily mean use all the senses together at once, rather it is a thoughtful consideration of how to make learning accessible through different sensory modalities. The goal is full access to education and the environment at every moment of every day. 

“Vision alone never ‘came into focus’ by itself. It had to be buttressed by something non-visual.”

The CVI Perspective

What does a multisensory approach look like?

When we think about best serving and teaching students with CVI, we think about access and unlocking potential. What is required for full access to learning and the environment? What tools do they need in their toolbox that will build skills and independence? What are the targeted interventions, accommodations, and adaptations that support not only visual access but multisensory access to create an accessible day and high-quality learning opportunities?

For every learning activity, consider this thinking process:  

  • What is the learning goal?
  • What skills are needed? What are the student’s strengths?
  • What concepts need to be understood? What concepts need to be directly taught due to the lack of access to incidental learning?
  • How can we incorporate experiential learning to build memory and context?
  • What are the CVI supports and adaptations for visual access?
  • What are the multisensory approaches (tactile, auditory, kinesthetic, olfactory) matched to the unique needs of the student that support access to learning and be a bridge to perception and understanding? How are we building their toolbox?
  • How will the student show their learning? What are the multisensory choices offered?

The path to literacy for individuals with CVI offers many opportunities for multisensory learning. (In fact, multisensory activities can enhance reading skills for all students.) Learning media for literacy can include pictures, tactile, print, Braille, auditory, and digital (LMA results will enable the school team to decide the most appropriate learning media for instruction). Many individuals with CVI share that reading long texts is incredibly fatiguing, and this is where other sensory channels can support access. Some prefer to listen to the audio version of a longer text, while others have found Braille books valuable. Some students with CVI are learning both print and Braille. Again, it’s about building that toolbox for lifelong learning and empowering the individual with CVI with the choice and autonomy to live fully. 

Learn more about making literacy decisions for students with CVI using a multisensory approach.

A step-by-step example of a learning task using a multisensory approach

The activity below is an example of using a multisensory approach to support progress towards the student’s math IEP goal. This second-grade student with CVI relies mainly on his tactile system for information. He can look at and recognize familiar targets (mainly 3D, some 2D) and familiar environments. Visual tasks are fatiguing, and he requires adapted materials and a quiet, simple environment when using his vision. 

IEP Math Objective: Given various math tools, the student will combine two addends with sums to 10 in isolation and within the context of a word problem given 3 out of 5 opportunities.

Warm-up

The student relies on routine and predictability, and always begins learning activities with a hand warm-up. Engaging his tactile system anchors him in the learning and can wake up his visual system. For this warm-up, the student plays with red and blue math cubes in a muffin tin—placing them all together or dropping one or two in a cup.

Two images of muffins tins with red and blue math cubes.
Task 1: Visual task

The student looks at two groups of a familiar image (an Instapot) presented on a black background on an iPad. The TVI highlighted the group of three Instapots in red and the group of two in blue. The student then answers questions about more and less, how many in each group, and how many total. The color-coding of red and blue through this entire learning activity is intentional. Many individuals with CVI rely on color-coding to support visual access.

Images of an Instapot on a black background. One group of three is highlighted in red and the other group of two is highlighted in blue.
Task 2: Tactile 

The student then goes back to the math cubes in the muffin tin to continue learning about more and less, number groupings and adding two plus three to make five. This switch to tactile respects the hard work of visually processing 2D images and keeps visual fatigue (and a shutdown from learning) from setting in. 

Two muffin tin trays. One has five red and blue cubes groups together. The other has one group of three and one group of two.
Task 3: Visual and tactile 

The tasks leading up to this point helped establish context and activate memory to process the math equation: 3+2=5. First, on a black magnet board, the teacher placed 3D foam numbers and math symbols: a red three, green plus sign, blue two, a green equal sign, and yellow five. Here the student can identify the numbers and symbols in the equation, take a number off and explore both visually and tactually, talk about the visual features of the numbers and math symbols, and even match the groups of math cubes to the correct number. 

3D foam numbers and symbols on a black magnet board make the math equation: 3+2=5
Task 4: Movement/kinesthetic

At this point, the student may be experiencing fatigue and getting antsy from a table-top activity. A gross motor movement task helps this student reset and regulate. (Families and individuals with CVI of all ages share that movement helps reset and reduce visual fatigue.) This movement activity continues the learning of the math activity. For example, the student can use whatever items are available (e.g. balls) for counting and grouping. Maybe they need to roll around on a mat, so they pass balls over to one side to make a group of five, then they take away two and place them over to the other side, and so on. 

Five balls, some green, some blue, a few that are spiky, all together on a black mat
Task 5: Putting it all together

The student shows off their learning! He finds the number two on the board and places it next to the correct group of math cubs in the muffin, and does the same for three. Then he puts the math cubes next to each other, counts them, finds the number 5 on the board, and places it on the muffin tin. Here, the student can answer some questions about the equation while still tactually and visually exploring his work. 

Two muffin tins. One has the numbers 2 and 3 with math cubes. The other has the number five with math cubes. One math cube per muffin cup.

It’s about rich and meaningful opportunities for learning

A multisensory approach is a whole-child approach. What is the child’s functional vision, and how are they using their senses to access the learning and the environment? For some children with CVI, vision is the primary sense and motor complexities complicate tactile exploration. For others, auditory input is incredibly challenging or unavailable, so they rely on kinesthetic, tactile, and visual channels. And for some, visual input is too unreliable at times or most of the time, so they rely on tactile, kinesthetic, and auditory channels. It’s about knowing the individual’s unique strengths with CVI and knowing what works best for them. It’s up to educators and providers to create rich and meaningful opportunities for learning. 

Learn more ideas about multisensory learning for math and literacy!

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