CVI: Form Accessibility

Written by: Rachel Bennett

At Perkins, we are a gathering place of ideas. The CVI visual behaviors synthesize current research and build on the work of leading theorists in the field. CVI is a lifelong disability and we want to ensure that all individuals with CVI are fully understood. The CVI visual behaviors are an ongoing need, they can change and they can improve for some, but the need never goes away. No one area is separated from the other—the CVI visual behaviors are highly connected and all can impact the individual with CVI at any time.

What is Form Accessibility?

Individuals with CVI have varying abilities to visually access objects or learning materials in different forms. Form refers to types of visual materials—real objects, three-dimensional (3D), two-dimensional (2D), abstract or symbolic.
This assessment area evaluates the most accessible media form based on the individual’s visual abilities, and includes evaluation of the visual accessibility of multicolored materials versus solid colored materials and attention to and recognition of 3D and 2D materials.
Some individuals with CVI can visually attend to and recognize 3D materials but struggle with interpreting flat, 2D materials.
Oftentimes, realistic 3D and 2D materials can be more visually accessible than cartoon-like or symbolic materials.

When it comes to CVI, it’s important to know that looking is not understanding. Concept development must be supported with a multisensory approach. At times, recognition is solely dependent on compensatory strategies.

When I look at things with a lot of different colors, it plays tricks on my eyes.
Aidan, high school student with CVI

What are some compensatory strategies related to form accessibility?

Use of color to identify items instead of the details and shape. For example, when looking for the red ketchup bottle in the fridge, an individual with CVI might mistakenly take out the red barbeque sauce bottle. Both have a similar color and perhaps shape, but the details are different. Color is a significant support when also supported by context. Using the color red to find the ketchup bottle in the fridge is supported by context as is using the color red to find a favorite toy on a toy shelf. For some, when vision is unreliable color and context are important compensatory strategies.
Rely on context to figure out what something is—using knowledge of the environment or task to decipher what something is. For example, when emptying the dishwasher, there are predictable items to expect. Something flat is most likely a plate or something deep and round is most likely a cup or a bowl. The utensils are always found in the same place, so a child with CVI may use this predictable place and their memory of spoons and forks to support recognition.
Use auditory cues to recognize an object, person, or place. For example, your child may recognize their friend only when they say something. Or they might recognize a character on a TV show by the music that’s associated with them.
Rely on additional prompts from a peer, adult, or teacher to support recognition. For example, needing the beginning sound of the word or a clue about what they are looking at.

When I read [print] it feels like my eyes are being pulled out from their centers. I have a hard time reading long passages because my eyes get tired after about two paragraphs.
Grace, elementary student with CVI

What are some look fors/questions when observing your child with CVI?

Some observable behaviors: attending and recognizing only specific forms of visual information (objects and/or 2D), misinterpreting objects and/or 2D presentations based on form, perspective, and size, difficulty generalizing recognition of certain objects across forms and environments, and increased fatigue when looking at certain visual materials.
What does your child feel most comfortable looking at—3D and/or 2D materials? Do they look briefly or do they look for a long time?
What does your child recognize most often—real objects, color photographs of real objects, color illustrations, abstract drawings, or black and white line drawings? Can they identify a familiar concept represented in an unexpected setting?
To what extent does your child visually recognize a real object when it’s upside down or at a different angle, perspective, or orientation?
To what extent does your child visually recognize a real object in a photograph that is a different size from the original object?
To what extent does your child recognize letters, shapes, and words?
Does your child recognize pictures in familiar books? Do they recognize pictures in unfamiliar books?

What are some examples of adaptations and accommodations?

All accommodations must be based on individual assessments. The following are meant to inspire and provide a general idea. Accommodations and instructional approaches must be student-specific. Access is individual.

A Learning Media Assessment (LMA)—completed after FVA and CVI assessment—is critical in determining the most accessible learning materials and how they are presented. The Learning Media Assessment should be completed multiple times during a child’s educational career and should be used informally to evaluate access to learning media on an ongoing basis.

Examples from a guide to common CVI IEP accommodations

Depending on your child’s learning needs, educators might:

use familiar 3D and 2D items for learning concepts and tasks.
use 3D/real objects to pair with written material and learning concepts.
when planning a unit, use 3D/real objects related to key concepts and learning goals of the unit.
pair 3D objects with a high-quality color photograph of that exact object to help your child comprehend the learning goals, tasks, activities, and literacy materials.
introduce new 3D/2D objects with similar elements to familiar 3D/2D objects.
use real color photographs.
use a specific font style, color, and size with modified spacing. These details would be determined through comprehensive assessment, such as a CVI Assessment paired with a Learning Media Assessment (LMA).
may provide opportunities to use visual forms while primarily using non-visual forms if comprehensive assessments deem it appropriate.

Check out adapting worksheets for CVI to learn about why worksheets are inaccessible to many with CVI and ideas on how to make worksheet learning accessible for individuals with CVI.

You don’t perceive objects as they are. You perceive them as you are.
David Eagleman

Following the science

Connecting current research on the brain, our visual system, and CVI to better understand the CVI visual behaviors.

Object recognition is the brain’s ability to visually perceive the different pieces that make up an object such as its color, shape, size, pattern, and texture, process that information, and then use those attributes and visual memory to identify the object. Object recognition relies on perception, which is influenced by our own individual knowledge, memories, experiences, and expectations.
Cells in the ventral visual processing stream are especially adaptive for object recognition and shape processing. While cells in the primary visual cortex respond to simple stimuli (color, texture, orientation, etc.), cells in the inferotemporal regions respond to much more complex visual stimuli like patterns, shapes, faces, places, objects, and words.
Perceptual constancy is the ability to continue to identify and recognize an object, even when the position, size, angle, viewpoint/shape, lighting, or color changes. This allows sighted individuals to recognize an object regardless of how it’s depicted. For example, a sighted brain recognizes an apple despite changes in color, angles, or context, and in 3D or 2D form (abstract color and black and white).
Visual Object Agnosia is the inability to recognize common objects, not due to impairments in memory, language, or the early visual pathway (Haigh, et al., 2018). There are two types of visual object agnosia:
- Apperceptive Agnosia is the result of damage to the occipital regions where one has difficulty or is extremely limited in perceiving visual information as a meaningful whole; in “discriminat[ing] between shapes, regardless of whether they are objects, faces, or letters, and they have no ability to copy or match simple shapes” (Banich and Compton, 2018).
- Associative Agnosia is the result of bilateral damage at the occipitotemporal border and is the inability to identify an object even though the person can describe it in detail; they “can ‘see’ objects but don’t know what they are seeing” (Banich and Compton, 2018).
Simultanagnosia is the inability to perceive a whole scene, environment, or picture; the inability to perceive more than one item at a time. Individuals with CVI might focus on one small part of a scene and miss another (larger) part entirely. Learn more about simultanagnosia. Damage to the parietal or occipital lobes can cause difficulty processing simultaneous visual information and difficulty shifting gaze between elements of a scene.
A recent study (Manley et al., 2023) investigated the ability of individuals with CVI to identify objects in two-dimensional form—five image-type categories: abstract and realistic line drawings (with and without color) and real color photographs. The discussion of results included:
- “CVI participants showed a significantly lower mean success rate and longer reaction time when identifying objects compared to controls.”
- “Crucially, in the CVI group, there was also a trend for success rate to progressively improve and reaction times to decrease when moving from abstract black & white images to color photographs, suggesting that cues provided by both object outlines and contours (i.e. form) as well as color are important for correct identification.”
- “As a group, the distribution of gaze in the CVI group was less aligned with the salient features of the image.”
- “The CVI group’s ability to correctly identify objects increased with increased image realism.”
CVI can affect the various aspects, areas, and processes of how the brain recognizes objects.
Learn more about the diverse ways CVI can impact object recognition from Dr. Corinna Bauer’s webinar on Ventral Stream Functions in CVI: Object and Face Perception.

Learn more about the development of the Perkins CVI Protocol.

References

Atkinson, J. (2017). The David Teller Award Lecture, 2016. Journal of Vision, 17(3): 26, 1-24.
Banich, M.T. & Compton, R. J. (2018). Object Recognition in Cognitive Neuroscience (pp. 167-197). Cambridge, United Kingdom: University Printing House.
Bar, M. (2003). A Cortical Mechanism for Triggering Top-Down Facilitation in Visual Object Recognition. Journal of Cognitive Neuroscience, 15 (600-609).

Behrmann, M. & Plaut, D. C. (2013). Distributed circuits, not circumscribed centers, mediate visual recognition. Trends in Cognitive Sciences, 17(5), 210-219.
DiCarlo, J., Zoccolan, D., Rust, N. C. (2012). How does the Brain Solve Visual Object Recognition? Neuron Perspective: 73 (415-434).
Good, W. V., Hou, C., & Norcia, A. M. (2012). Spatial contrast sensitivity loss in children with cortical visual impairment. Investigative Ophthalmology & Visual Science, 53(12), 7730-7734.
Grill-Spector, K., Kourtzi, Z., & Kanwisher, N. (2011). The lateral occipital complex and its role in object recognition. Vision Research: 41 (1409-1422).
Haigh, S. M., Robinson, A. K., Grover, P., & Behrmann, M. (2018). Differentiation of Types of Visual Agnosia Using EEG. Vision (Basel, Switzerland), 2(4), 44. doi:10.3390/vision2040044
Lueck, A. H. & Dutton, G. N. (2015). Intervention Methods: Overview and Principles. In A. H. Lueck & G. N. Dutton (eds). Vision and the Brain: Understanding cerebral visual impairment in children (pp. 497-536). American Foundation for the Blind Press.
Manley, CE, Walter, K., Micheletti, S., Tietjen, M., Cantillon, E., Fazzi, E., Bex, P., Merabet, L (2023). Object identification in cerebral visual impairment characterized by gaze behavior and image saliency analysis. Brain Dev (2023).
Roman-Lantzy, C. (2018). Cortical Visual Impairment: An Approach to Assessment and Intervention. 2nd ed., New York, NY: AFB Press.
Tietjen, M. (2019). The ‘What’s the Complexity?’ Framework. In Roman-Lantzy, C. (Ed.). Cortical Visual Impairment: Advanced Principles (pp. 92-159). Louisville, KY: APH Press.