CVI: Impact of Clutter

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 the Impact of Clutter?

An individual’s ability to attend to, recognize, and/or navigate materials or environments with varying levels of visual clutter.
Clutter is one of the greatest barriers to access for people with CVI.
The more visual clutter, the more to look at, switch between, and ignore, making visual attention difficult or near impossible. More visual stimuli mean the more the brain needs to ignore and rule out and the more visual search that’s required.

People with CVI may:

have difficulty with visual attention and recognition with clutter, when objects are spaced too closely, or with an unpredictable arrangement
have a hard time with visual sorting and perception, and when lots of items compete for their attention, it’s even harder to focus.
only be able to see one thing at a time; this is known as simultanagnosia
be able to better see an object against a simple backdrop
perceive closely grouped objects as a single object
not be able to distinguish an object from others in the background (figure-ground)

This clutter, combined with the overload of other sensory information, such as the constant noise, movement and smells of a classroom full of students, meant that I spent the whole school day feeling anxious and on edge. Being in these cluttered environments was also exhausting and I soon learnt, that the only way I was going to survive each day, was if I allowed myself some quiet time during break times. These solitary time outs ended up becoming one of my most important strategies for dealing with the anxiety, confusion and fatigue my visual issues created.”
Nicola McDowell’s Blog (20): The war on cluttered classrooms

What are some compensatory strategies related to the Impact of Clutter?

People with CVI may use compensatory strategies (color-coding, memory, prediction, context, tactile, auditory) to find items in clutter. When the world is essentially cluttered for a person with CVI, it’s important to encourage the use of compensatory strategies to help reduce fatigue and support their choices for how they want to access their world.

Some with CVI may:

create predictable and organized environments so they can rely on memory to navigate environments and find items
use the context of the environment or task when clutter interferes with attention and recognition.
use color-coding to find and identify items when the shape and details are unrecognizable. Color is often how many with CVI track an unrecognizable visual world.
use tactile skills to explore items in a cluttered presentation or environment.
clear/swipe cluttered areas.
dump out boxes filled with items so they can spread out, touch, and eventually find a certain item.
line up and arrange objects in predictable displays.
bang the table to make items move.
bring things near to remove background clutter.
put their head down, close their eyes, and/or fall asleep.
become agitated, stressed, and/or anxious.
tilt head or position body due to reduced visual field in the presence of clutter.

A lot of kids with CVI we work with tell us about the frustration they experience, the sensitivity to clutter, and how exhausted they are at the end of the day. We think this is because their visual system is not as efficient as it should be—the brains of individuals with CVI have to work harder to carry out visual tasks that may be very simple to someone else.
Dr. Lotfi Merabet

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

Is your child able to find things on a cluttered surface or visually busy background? Do they use only their vision or other compensatory strategies (touch, banging the table to make items move, adult prompting, verbal descriptions)?
How does your child react when in environments that have visual clutter (for example, decorations on the wall, a lot of furniture and items, groups of people, shelves stuffed with items, messy table tops and floors)? Do these cluttered spaces affect visual attention and recognition? Do they become anxious, stressed, and/or develop behaviors that show it’s hard to use vision and be in the cluttered space?
Does your child misidentify items in visually busy presentations? For example, images and text on a busy worksheet, a 3D object in a group of 3 or more, a character in a picture book when surrounded by other illustrations, a word on a page of text, or locating a person in front of a visually cluttered background.
How does spacing between items support the ability to look at and recognize an item? Does your child like to space out and organize a random pile of items to support looking and recognition?
To what extent does your child use their compensatory strategies (color-coding, memory, context, tactile, auditory) to find items in clutter?

“If [an object] was mixed in with a bunch of things? Yeah, I could figure it out, but it’d be harder to recognize what I’m looking for.”
-Aidan, teenager with CVI

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.

Examples from a guide to common CVI IEP accommodations:

Your child may need to face away from visual clutter (wall decorations, bulletin boards, bookshelves, messy stacks of items) and face a simple, plain background during learning activities.
Your child may need a learning environment with reduced visual clutter: plain walls and minimal decor; solid-color carpet or floor; reduced number of items on shelves, bookcases, or shared surfaces.
A classroom should have predictable places for personal items, resources, and learning materials so your child knows where to find and return things.
The educator is often the backdrop to learning. Objects and materials held in front of them can become merged with clutter if the educator is wearing complex attire. Having a plain or black cover-up on hand can be helpful.
School teams may need to:
- use dark and/or plain backgrounds for learning and presentations.
- remove all extraneous information from the photograph (i.e. a picture of only a character from a story without the background scene).
- space out objects or materials so that they are easily recognizable.
- increase spacing between items for visual access and for optimal successful visual-motor skills.
- mask/block non-essential visual information from your child’s view (textbooks, worksheets etc.)
- standardize presentation methods for learning, choice-making, communication systems, literacy, and ADL sequences.
- use predictable routines so that your child becomes more aware of materials and links the material to the activity.
- allow for close-range examination of materials.

I have trouble seeing in crowded areas.
Krish, elementary student with CVI

Following the science

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

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.
Serial processing is scrutinizing one piece of information at a time when there is more sensory information to take in, while parallel processing is being able to process many elements of a visual scene at the same time. Serial processing is a less efficient form of visual search. Dr. Lotfi Merabet discusses that with an increased visual load, individuals with CVI have to grind it out (serial processing), as opposed to having that instantaneous capture of information we see with a really efficient visual system.
Dorsal stream dysfunction often leads to distress in crowded and noisy locations, inability to find an object in clutter, a friend in a group, or to read.
The brain has to keep track of what it’s looking for and ignore information that is not relevant. When searching for an object, it’s not just about where to look, but also where not to look. For sighted individuals, their visual system does this unconsciously. With CVI, the more visual information and visual task demands, the more difficult it is to know where to look and where not to look, and to control where the brain is attending to, all of which can lead to frustration, fatigue, anxiety, and stress.

Learn more about the development of the Perkins CVI Protocol.

References

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Bennett, C. R., Bex, P. J., & Merabet, L. B. (2021). Assessing visual search performance using a novel dynamic naturalistic scene. Journal of vision, 21(1), 5.
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McDowell, N., & Budd, J. (2018). The Perspectives of Teachers and Paraeducators on the Relationship between Classroom Clutter and Learning Experiences for Students with Cerebral Visual Impairment. Journal of Visual Impairment & Blindness, 112(3), 248–260.
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