Instructional considerations for CVI and remote learning

Ideas for children with CVI that address visual access and multisensory learning

Child looking at an image of one of his tangible symbols on a computer screen while touch the symbol on his magnet board

With the understanding of foundational components of Cortical Visual Impairment/Cerebral Visual Impairment (CVI) and remote learning, how to set up a learning space to better enable visual access, and tips on how educators can present themselves on screen, let’s now dive into some instructional considerations for the unique needs of children with CVI. 

While there are many ways that CVI manifests in children, along with different assessment tools and evaluation areas to consider, here are some general instructional strategies for addressing visual attention and/or recognition. You can also think of these strategies in relation to the goal-focus areas across Dr. Roman-Lantzy’s Phases of CVI (I, II, III).

What’s important to keep front and center is that multisensory and experiential learning is critical to actively building new connections in the brain. Remote learning should not only be learning through a screen, no matter the visual abilities of the child with CVI. By integrating vision with action and other senses, children with CVI will have richer opportunities to build functional vision. 

Dr. Lotfi Merabet noted in his Q&A about CVI and the Brain: “Let your child be active, interactive, and explore in order to create a situation that promotes as much recovery as possible. Keep the brain gears turning! … The more engaged the child is, the more they will find motivation to continue to explore and interact, and in principle, the more the brain will continue to grow, change, and develop.”

Instructional considerations for children with CVI building consistent visual attention (Roman-Lantzy’s Phase I/Early Phase II):

  • Instruction is supported by three-dimensional (3D) objects available at home. Two-dimensional (2D) targets are inaccessible and there is limited visual recognition of anything on the screen. Visual attention to the presenter on the screen may occur due to light, movement, and color. Use the teacher’s instruction as a model for presenting the 3D object to your child. Continue to incorporate multisensory tasks. 
  • Ongoing collaboration between parents and educators prior to 1:1 sessions will support more successful outcomes. Educators should share the learning plan and content, so parents have time to find all the needed objects for the lesson. Part of the learning plan should include specifics about how the parent should present objects (slow movement, in front of a plain black background, in preferred visual field). 
  • Predictable learning routines to provide anticipatory cues and anchor the child in the learning experience. Depending on your child’s accessible learning media, consider using a 3D calendar system to symbolize specific parts of the lesson (tasks at beginning, middle and end). The symbols used in the calendar system should align with recommendations from essential assessments.
  • Brainstorm ways to generalize instructional goals across meaningful routines. For example, allow time for your child to visually attend to items during their bath routine (soap, loofah, shampoo bottle) and complete the routine in a set order. This again supports that visual memory and predictability. If you need support in thinking about ways to build visual attention, consider scheduling a 1:1 session with the educator during a natural routine, such as mealtime. 
  • Use of compensatory skills to support visual access. Provide a verbal label of a 3D item or action. Everything we know is based on our foundational knowledge, understanding of and interactions with objects. Create attribute trays to teach foundational concepts and categorizations. Describe salient visual and tactile features of objects as the child explores objects (such as round, pointy, long, short, soft or hard). For example, use a small figurine of Cookie Monster with a larger plush version of Cookie Monster to work on small and big, hard and soft, and color. 
  • Reduce back and forth chatter during the learning session. The educator should stay quiet as the parent works to gain the child’s visual attention. Any conversation that is needed between the educator and parent should occur before or after the session to reduce sensory complexity while the child is engaged in their learning. Allow wait time for visual attention. And be mindful that there might be a lag in response time due to internet connectivity issues. 

Instructional considerations for children with CVI integrating vision with function (Roman-Lantzy’s mid-late Phase II):

  • Instruction is supported by both 3D objects available at home and familiar 2D images on the screen. The transition from 3D to 2D can be tough for children with CVI. It can also be impacted by the form of the 2D image (for example, simplified photograph versus a colorful Mayer-Johnson). Some children in Phase II may have some visual recognition of the familiar materials on the screen. Visually attending to 2D is fatiguing, so it should be managed during the remote learning session. Continue to incorporate multisensory tasks.  
  • Ongoing collaboration between parents and educators prior to 1:1 sessions will support more successful outcomes. Educators should share the learning plan and content, so parents have time to find all the needed objects for the lesson. Or for parents to send photographs of familiar objects/materials to incorporate in the lesson. 
  • Predictable learning routines to provide anticipatory cues and anchor the child in the learning experience. Depending on your child’s accessible learning media, use a visual/tactual 2D or 3D calendar system to symbolize specific parts of the lesson (tasks at beginning, middle and end). The symbols used in the calendar system should align with recommendations from essential assessments.
  • Present 2D material specific to the child’s assessment results. For example, the child is able to attend to an array of three 2D targets four inches apart on a plain black background in their preferred visual field. Programs like PowerPoint, Google Slides, or Keynote allow for optimal presentation of 2D material. Educators may share their screen during a lesson, so the child can engage with the 2D material. If needed, parents can request to have all learning materials sent via email prior to the virtual session. 
  • Use of compensatory skills to support visual access. Use descriptive and anticipatory language to talk about the learning tasks for the session. Incorporate familiar 3D objects to support the 2D version on the screen. For example, describe the salient visual features of the Cookie Monster doll as the child tactually explores it and then have the child attend to a photograph of the exact same Cookie Monster. Some children with CVI may benefit from a hand warm up (playdoh, pull apart magnet or velcro blocks, exploration of textures, playing with food items) to activate their vision use. 
  • Stay quiet while the child is viewing the material and establishing visual attention. Allow wait time for visual recognition. And be mindful that there might be a lag in response time due to internet connectivity issues and limited familiarity with the task or materials. 

Instructional considerations for children with CVI who have functional vision, but CVI visual behaviors and characteristics still remain (Roman-Lantzy’s Phase III):

  • Instruction is supported by 3D, 2D pictures, and/or print. Follow CVI assessment recommendations (Roman’s CVI Range, Tietjen’s Image Assessment) and the Learning Media Assessment for 3D/2D presentation; size, font and color; and array and spacing between objects, pictures, letters, word and sentences. If your child has a speech-language pathologist on their team, be sure to consider their recommendations surrounding communication level and mode(s). Continue to incorporate multisensory tasks. 
  • Ongoing collaboration between parents and educators prior to 1:1 sessions will support more successful outcomes. Educators should share the learning plan and content, so parents have time to find all the needed objects for the lesson. Parents can send photographs of newly familiar objects/materials or videos to incorporate in the lesson. 
  • Predictable learning routines to provide anticipatory cues and anchor the child in the learning experience. Use a visual calendar system to symbolize specific parts of the lesson (tasks at beginning, middle and end). 
  • Connect novel 2D learning to previously learned concepts and materials. For example, if the child is learning about the water cycle during science class, break down the complex diagram into known parts. Begin with real life experiences. For example, explore water (stream, pool), think about a time when the child swam in the ocean, feel the morning dew and find the trees. The child might be able to recognize pictures of the ocean and trees, but not be able to recognize an image of rain falling from the clouds. Connect this novel image to the child’s real-life experience with rain and show a video of the child in the rain. Use a simple video of the rain falling and from there go back to the rain image that is part of the water cycle. Compare what is known from these multisensory experiences to the 2D image. Discuss and highlight (in the child's preferred color) the salient visual features of the 2D image.
  • Use of compensatory skills to support visual access. Use descriptive and anticipatory language to talk about the learning tasks for the session. Describe salient visual features of 2D pictures to support discrimination of detail. Incorporate visual breaks that include a switch in sense (auditory, tactile, movement) while continuing the learning process.
  • Stay quiet while the child is viewing and interpreting the material. Allow wait time for visual recognition. And be mindful that there might be a lag in response time due to issues with the wifi connection. 

Want more ideas? Read about examples of instruction based on home routines.

Reference:

Roman-Lantzy, C. (2018). Cortical Visual Impairment: An Approach to Assessment and Intervention. 2nd ed., New York, NY: AFB Press.