CVI: Visual curiosity and incidental learning

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 area of visual curiosity?

This area is the culmination of the collective impact of all the CVI visual behaviors on the difficulty or inability to access incidental learning (or learning from observing the world around you). Many with CVI have difficulty being visually aware of their full surroundings, both at near and at a distance. Vision is a distance sense, where those who are sighted don’t have to physically engage with something in order to observe it and learn from it. Vision is used to verify what’s beyond arm’s reach. When vision becomes reduced, so does incidental access to information and learning.

Some with CVI may:

Have challenges visually understanding what is around them and what it means.
Have difficulty noticing and recognizing objects and people at varying distances.
Be less likely to explore surroundings, especially if less familiar.
Not be able to rely on visual information and fill in those gaps in visual access with assumptions about how things and people relate to you.
Have difficulty making inferences and generalizations; and inferences from social interactions (facial expressions, body language).
Show a reduced interest in looking at or engaging with less familiar things.
Have difficulty linking auditory and tactile input to visual events.

Important: Incidental learning often is limited, but that doesn’t mean learning is limited. There are many instructional strategies to make information available: multi-sensory learning, direct instruction, variation in learning media (visual, auditory, tactual), changes to the environment, and supporting sensory efficiency and compensatory strategies.

I found it difficult to absorb information at a distance simply because much of the distinctiveness was lost. The main things I could absorb at a distance were plain landscapes, like a gray sky on a cloudy day, which I found comforting (more so than on a sunny day because the light was too overwhelming)… The distance was the coconut base to a rich curry dish—it was sort of there, but also mostly wasn’t there. It flew under my awareness and didn’t jump out over the spicy vegetables enough to inspire curiosity.
Nai, The CVI Perspective

What are some compensatory strategies related to visual curiosity and the difficulty with visually accessing the surrounding environment?

People with CVI have strategies and workarounds for so much in their daily lives. When accessing incidental learning and items in all fields of view and at a distance, many with CVI rely on their compensatory skills.

Some people with CVI may rely on:

Tactile exploration of items and the environment
Sound cues from objects, people, and the environment
Verbal cues to understand what and who is around them and at a distance
Color-coding to support recognition and navigation
Context to help fill in the gaps in vision and cue past experiences and memory
Predictability and organization to locate items, people, and places in the environment

My daughter sees better up close. Some things have been in our home for her entire life that she hasn’t noticed. Then, one day she will discover it as though it is brand new!
CVI Parent

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

Can the child with CVI do something new that you’ve visually demonstrated? Do they watch an entire demonstration (e.g. kicking a ball, rolling playdough, playing a musical instrument)?
Does the child with CVI watch you at any distance and anticipate an upcoming activity?
Will the child with CVI look and point directly to items of interest at near and at a distance? In familiar and unfamiliar environments?
When entering an environment, does your child look around with curiosity?
Do they rely heavily on color to visually search for things?
To what extent do they identify familiar landmarks in both new and familiar environments?
Does the child with CVI point to or comment about objects or activities across the room that they visually observe?

Vision fundamentally facilitates learning, leading to knowledge, skills and traits that will shape the child’s personality and cognition. If children with CVI are not identified and appropriate measures taken to ensure that all educational input is visible or rendered accessible by alternative means, they cannot learn within any domain limited by their unique pattern of visual impairment.
Chokron and Dutton, 2016

What are some examples of adaptations and accommodations?

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

With CVI’s impact on visually accessing one’s surroundings both at near and at a distance, the effects are far-reaching and require a targeted instructional approach to effectively serve and support students with CVI.

Direct and explicit instruction to develop rich concepts in all areas of learning. Many foundational skills for literacy and numeracy come from incidental learning. Educators and providers must provide direct instruction in all the skills and concepts needed to master a learning goal.
Multisensory learning to ensure active engagement: Provide multiple opportunities and various sensory channels for students to learn about new concepts and show their learning. We have a wide range of design tools available to meet the individualized learning needs of each student with CVI—auditory, kinesthetic, tactile, and visual. Bring what’s at a distance to near and have the student engage in the activity that their sighted peers learn by observation. Use real objects, manipulatives, experience stories, active learning approaches, story boxes, and hands-on activities.
Create a strong sensory foundation for concepts in the natural environment (people, objects, actions, and places) to then ensure that communication symbols (tangible, auditory, visual) about these concepts are meaningful. Learn more: SAM: Symbol and Meaning by Millie Smith
Link sounds and tactile input to visual events: Use language to connect sensory experiences, help build connections, and label events, feelings, and situations. Some with CVI are at risk for developing “empty language” or vocabularies not rooted in meaning. For example, the sun is an item that’s warm or fire is the sound of the siren of a fire alarm.
Verbal descriptions of the surrounding environment: provide verbal information during social situations. For example, “Your friend is waiting outside the classroom in her green coat.” When there are sounds within the environment, share what they are and, if possible, bring them to the source to build upon their visual and auditory memory.
Color-coding in the environment to provide consistent destination indicators on locations that can be seen both at near and at certain distances. Incorporate intentional use of color to support attention to landmarks and details in the classroom.
Adapt the classroom environment. Leave some walls blank, allowing for more seating and learning options for a student with CVI. Remove unnecessary furniture, equipment, and boxes. Organize open shelving using single-colored opaque bins. Educators should minimize background clutter in the space where they usually stand to speak to the class. Create a quiet break time zone for the class. This should also include two blank walls (every student can benefit from a calm space to reset). Create predictable places for resources and learning materials so students know where to find and put things back. Use single-colored plain carpets.

Find more examples from a guide to common CVI IEP accommodations in the CVI Now IEP Guide.

My son often relies on memory to attempt to fill in what can’t be seen beyond arm’s reach. We’ll be driving around town, and he’ll scream out, “oh there’s our ice cream place!” But we’re nowhere near our neighborhood ice cream shop. He knows that his sister’s old school was near the bridge over the highway. Anytime we’re driving over the highway, he’ll shout, “oh there’s my sister’s school!” But we’re nowhere near her school. When riding the train and it stops at a station, he’ll say, “there’s the other train!” But it’s a side platform and he’s pointing to a wall.
Rachel, CVI Parent

Following the science

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

This area of CVI is the culmination of all the other CVI visual behaviors. Below is a summary of research to show the profound impact of CVI on access to the surrounding environment, both at near and at a distance.

Vision has a fundamental role in a child’s visual development, and CVI can compromise learning, behavioral development, and interaction with the outside world (Chokron & Dutton, 2016). Visual experiences are the first involved in the development of mental representations, which are critical for the development of concepts and abstraction (Chokron, Kovarski, Dutton, 2021).
Environmental factors that can be potential barriers to perception, attention, and learning need to be adjusted in ways that turn them into potential learning supports (Lueck & Dutton, 2015).
Damage or interruption to the ventral visual stream can cause difficulties with contrast sensitivity, depth perception, identifying and interpreting objects and faces, and route-finding. 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).
Damage or interruption to the dorsal visual stream can cause difficulties with spatial perception, perception of movement, visually-guided reach, accurately and safely walking around obstacles, and distinguishing between multiple objects when presented with an array. Dorsal stream dysfunction contributes to difficulty with visual attention in the presence of competing stimuli: leads to distress in crowded and noisy locations, inability to find an object in clutter or a friend in a group. (Chokron, Klara, & Dutton, 2021).
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. When additional sensory input is added to an already overloaded and overtaxed visual system, things will start to shut down.
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.
Research shows various ways visual fields can be affected: Lesions or dysfunction affecting the optic tracts, lateral geniculate nuclei, optic radiations, or primary visual cortices can cause visual field loss (Lueck & Dutton, 2015). The superior optic radiations can also be affected, causing lower visual field impairment, which ranges from being complete to solely rendering the feet invisible when walking (Chokron & Dutton, 2016).
Visuospatial neglect, or visual inattention, is the difficulty detecting or acting upon visual stimuli on one side of space. This is different from visual field loss in that full visual fields are available, but the brain does not give the attention needed to be aware of visual stimuli in a specific visual area. The person with CVI may behave as if half of the space on one side does not exist. For example, if there is damage or interruption to the right posterior parietal lobe, there may be visual neglect or inattention to the left-hand side. Increased clutter and visual stimuli density can make visual neglect more severe (Nijboer and Stigchel, 2019).
Prosopagnosia (face blindness or facial agnosia) is a “neurological disorder characterized by the inability to recognize faces.” Prosopagnosia from occipitotemporal damage is associated with right or bilateral loss of the fusiform and/or occipital face areas (Barton et al, 2021). It’s important to note that other CVI behaviors can also cause difficulty with facial recognition, including simultanagnosia, the impact of clutter, visual field loss, reduced visual acuity, and reduced contrast sensitivity.
Dyskinetopsia is atypical movement processing and includes difficulty processing things that are moving quickly. Motion is processed more slowly because the brain has a hard time matching the real-time movement of the object. Dyskinetopsia is a spectrum. According to Dr. Gordon Dutton, “if it’s mild, some things may be missed or partly seen. If severe, much of the world around the person can be missed.” One way to help is to slow down movement. (Dyskinetopsia, CVI Scotland)

References

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Braddick, O. and Atkinson, J. (2011). Development of human visual function. Vision Research, 51 (13), 1588-1609. https://doi.org/10.1016/j.visres.2011.02.018Banich, M.T. and Compton, R. J. (2018). Cognitive Neuroscience. Cambridge, United Kingdom: University Printing House.
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Bennett, C. R., Bauer, C. M., Bailin, E. S., & Merabet, L. B. (2020). Neuroplasticity in cerebral visual impairment (CVI): Assessing functional vision and the neurophysiological correlates of dorsal stream dysfunction. Neuroscience and biobehavioral reviews, 108, 171–181. https://doi.org/10.1016/j.neubiorev.2019.10.011
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