Video

CVI: Visual Guidance of Upper Limbs

Learn about the impact of motion and difficulty with motion perception, what this assessment area looks at, and general ideas for accommodations.

Access the video transcript

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 Visual Guidance of Upper Limbs?

Visual guidance of upper limbs (arms, hands) is part of the broader category of visually guided movement of the limbs and body. People with CVI may:

Dinner is a messy affair at our house. My son either knocks over his drink or puts the cup too close to the edge and it falls off. We’re used to it!

CVI Parent

What are some compensatory strategies related to Visual Guidance of Upper Limbs?

Many with CVI build strategies to compensate for difficulty with visual motor skills. Some of these strategies include:

[Regarding not being able to look while reaching or with other sensory stimuli:] What I don’t agree with is that [people without CVI] usually refer to this like it’s a bad thing… What people who don’t have CVI don’t realize, is that I only look at things when I absolutely need to. I look at things when I’m reading, for instance, but most daily activities don’t require looking.

Teenager with CVI, Yellowstone Blog 1 on CVIScotland.org

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

When it comes to observing visual motor skills, take into consideration how these skills are impacted by color, motion, field, clutter, light, recognition, competing sensory information, the familiarity of object or environment, in addition to fatigue and time of day.

My son has a difficult time using visual-motor skills. He’ll reach past something, around it, or stop short of it. He often uses tactile skills when searching and reaching for something. He rarely looks and reaches at the same time. And that’s okay! He has strategies that work for him. He uses his vision when he wants to. When the task and environment allow visual access (reduced clutter, noise, and movement, and accessible materials), he’ll visually guide his arm and hand. But after a certain point that still becomes fatiguing.

CVI Parent

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. 

A team must consider all the other CVI visual behaviors when supporting visual motor tasks, along with the student’s whole-child needs. What compensatory skills can we leverage to make sure the full learning task is accessible? The goal isn’t simply for the child to look while reaching, the goal is to make learning accessible. If visual motor tasks are fatiguing (i.e. cutting out letters to stick on a worksheet or handwriting a paragraph), it’s essential to always go back to the learning goal—do these visual motor tasks need to be a part of the learning activity in order for the student to learn a new concept or skill?

Find more examples from A Guide to Common CVI IEP Accommodations in the CVI Now IEP Guide. 

Following the science

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

Learn more about the development of the Perkins CVI Protocol.


References

Atkinson, J. (2017). Visual Brain Development: A review of ‘‘Dorsal Stream Vulnerability’’—motion, mathematics, amblyopia, actions, and attention. The David Teller Award Lecture, 2016. Journal of Vision, 17(3): 26, 1-24. 

Atkinson, J., & Braddick, O. (2011). From genes to brain development to phenotypic behavior: “dorsal-stream vulnerability” in relation to spatial cognition, attention, and planning of actions in Williams syndrome (WS) and other developmental disorders. Progress in Brain Research, 189, 261–283. 

Chokron, S. & Dutton, G. N. (2016). Impact of cerebral visual impairments on motor skills: Implications for developmental coordination disorders. Frontiers in Psychology 7(1471), 1-15.

Chokron, S., Klara, K., & Gordon D. (2021). Cortical Visual Impairments and Learning Disabilities. Frontiers in Human Neuroscience 15, 573. 

Goodale, M. A. (2013). Separate visual systems for perception and action: a framework for understanding cortical visual impairment. Developmental Medicine and Child Neurology, 55(4), 9-12.

Greulich, R. S., Adam, R., Everling, S., and Scherberger, H. (2020). Shared functional connectivity between the dorso-medial and dorso-ventral streams in macaques. Sci. Rep. 10, 1–17.

Kelly, J., Phillips, J., Saneto, R., Khalatbari, H., Poliakov, A., Tarczy-Hornoch, K., & Weiss, A. (2021). Cerebral visual impairment characterized by abnormal visual orienting behavior with preserved visual cortex activation. Investigative Ophthalmology and Visual Science, 62(6), 1-11.

Lueck, A. H., & Dutton, G. N. (2015). Vision and the Brain: Understanding Cerebral Visual Impairment in Children (pp. 497-536). New York, New York: American Foundation for the Blind Press.

Philip, S.S. and Dutton, G.N. (2014), Cerebral visual impairment in children: a review. Clin Exp Optom, 97: 196-208.

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

Van Polanen, V., and Davare, M. (2015). Interactions between dorsal and ventral streams for controlling skilled grasp. Neuropsychologia 79, 186–191.

Whitwell,R., Sperandio, I., Buckingham, G., Chouinard, P., Goodale, M. (2020). Grip Constancy but not Perceptual Size Constancy Survives Lesions of Early Visual Cortex. Current Biology. Vol 30, Issue 18. https://www.sciencedirect.com/science/article/pii/S0960982220310186

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