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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 recognition?
Visual recognition is perceiving an item, animal, or person and knowing what is because you have seen it before or seen something similar. When we recognize something, we compare something in view to the huge library in our visual memory. We have a visual template that we are consistently using to match what we see. We make connections between what we are seeing and what we have known before based on shape & size, function, context, language, feel, sound, and other senses. Each time we see an object and interact with it in a meaningful way, our visual reference library is strengthened. Recognition relies on stored information and the ability to retain and recall that information.
The act of visual recognition requires perception (being able to detect and see something), prior knowledge (having seen that something before), and linking the perception to that stored memory of the perceived item–being able to access your memory bank and pull out the relevant information.
Dr. Corinna Bauer, Ventral Stream Functions in CVI: Object and Face Perception.
Difficulty with visual recognition is a big part of CVI. People with CVI may have difficulty recognizing objects, animals, visual scenes, environmental targets, people, faces, and many other facets of our visual world. Without recognition, the world becomes a barrage of meaningless visual input. CVI has diverse manifestations, and visual recognition skills fall on a spectrum. Some with CVI may read print and chapter books and recognize a wide variety of objects, but they have trouble walking down a hallway or navigating a new, unrecognizable environment. While others with CVI may have difficulty recognizing objects they’ve seen before or processing 2D materials, such as pictures and print text.
People with CVI may not recognize something because it can’t be seen well (difficulty with input), it’s not known (no prior experience), or both—when the visual input is unclear and they may not have prior knowledge of it (Bauer, 2021). It’s important to remember that many factors may cause a person with CVI not to see well (even if the person has normal/near-to-normal acuity): fatigue, competing sensory inputs, stress, illness, visual field loss, co-occurring physical or neurological conditions, or new places and tasks. And to layer on that, many with CVI also have eye conditions, which can compound an already complex visual impairment. If something is not perceived because it’s not seen well, it can’t be recognized.
For sighted people, seeing something once or a few times, whether through incidental passive observation or direct interaction, is enough to create a visual memory that can then be used to recognize an object, even if the position, size, angle, perspective, shape, lighting, or color changes (also known as perceptual or form constancy). For example, a child sees a duck walking by a pond and the parent says, “Oh look at that duck!” During nighttime read-aloud, there are pictures of ducks in the story that the child immediately recognizes. These experiences build the memory of the visual attributes of ducks, which can then be applied to many iterations: actual ducks in the real world, pictures, and abstract drawings in different sizes, colors, and angles.
The child has “duckness,” a term that Ellen Mazel, a leader in the CVI field, discusses a lot: “Our children with CVI lack this visual access to ‘duckness.’ They lack the expanded and repeated knowledge about ducks. If they have seen a duck, their idea of ‘duckness’ is limited to that one duck.”
The way we see the world is heavily influenced by what we expect to see.
Dr. Lotfi Merabet
For many with CVI, the brain has difficulty building a robust visual library. Even when the brain can add an item to the visual library, applying that visual memory to unfamiliar versions of a well-known object can be extremely challenging, this is why repetition and familiarity are important foundations for instruction and learning.
People with CVI may have difficulty building a robust library of visual memories because
- The object currently in view may be inaccessible
- Opportunities to view the accessible object may be limited
- Viewing and interacting may not be linked
- Visual memory may be fragile
- Generalization may be limited
- Other senses may take the lead
- Fatigue and sensory overload may make vision nearly impossible
People with CVI may rely on compensatory skills to help track an unrecognizable visual world (listen, touch, color, context, prediction, memory). As sighted individuals, we can take for granted the amount of information we acquire visually. For example, we know that an unsanded piece of wood will be rough just from looking at it.
Some with CVI may recognize:
- A small group of accommodated objects
- Only their own version of an object, but not others
- An object in a predictable context
- An object in a familiar and/or predictable position
Remember looking is not understanding. Ask an individual what they see and experience. The establishment of relationships and parent/caregiver knowledge is essential. Comprehensive CVI assessment must go beyond eye-to-object fixation and deeply evaluate visual recognition and all the strategies a person with CVI uses to figure out what something is. For an evaluator to know there is visual recognition, a reliable response from the individual with CVI is required, whether that be vocalizations, speech, facial expressions and body language, sign language, and other manual gestures for example. To the extent possible, having the person with CVI participate in their interview for their assessment is another way to document recognition and related strategies.
I can recognize things only if they are highly familiar and if I use them frequently. I use my Mickey Mouse mug every day. I can recognize it in any setting, but it would be harder for me if it was mixed in among several different objects.
Micah, a young adult with CVI
What are some compensatory strategies related to visual recognition?
People with CVI have strategies and workarounds for so much in their daily lives, and compensatory skills to help track and make sense of an unreliable visual world. At times, recognition may be solely dependent on compensatory strategies.
- 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. The color red to find the ketchup bottle in the fridge is supported further by context and touch. 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. When the friend or family member is out of context, auditory cues can be even more of a support. Some individuals might recognize a character on a TV show by the music associated with them. Some might listen while shaking a box that has toys or snacks to help figure out what’s inside.
- Use tactile cues to recognize an object or place. Touch can be a great verifier when the brain cannot make sense of the visual input. Exploring a toy, food, or utensil using touch can help a person with CVI figure out what the object is while also helping to solidify concepts. When exploring a place, toe-tapping can help make sense of surface and depth changes, or touching different elements of the environment can help build an experiential memory.
- 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.
As for objects? Now, that’s where things got dicey. I would try to identify objects and would fail, often hilariously. I guess this is what the scientists call visual agnosia. I remember seeing a patch of gray against a yellow background at home once. I knew our couch was yellow, and I knew my cat was a gray tabby. I excitedly got on the couch and curled up next to my sweet baby, looking forward to his warm soft fur, only to find that my “sweet baby” was actually a rough, cold, stiff blanket.
Nai Damato, adult with CVI, The CVI Perspective
What are some look fors/questions when observing your child with CVI?
- What does your child recognize most consistently—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 are objects recognized when presented out of context? Outside of predictable routines? Without tactile exploration? Without auditory cues?
- 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?
- Do cluttered backgrounds increase, decrease, or have no impact on your child’s ability to visually recognize a target?
- Does the motion of an object or self-motion support visual recognition?
- Does backlighting or task lighting increase or decrease the ability to recognize objects and/or 2D materials?
- To what extent is color used to support recognition? Is the individual’s recognition of objects dependent on color? Is the individual’s recognition of people dependent on the color of attire or hair? Does color support recognition at increased distances?
- How do noisy and busy environments affect visual recognition (increase, decrease, or have no impact)?
- Does your child recognize familiar people without hearing them speak? Does your child recognize a family member outside their usual context (without voice prompts)?
- Does your child mistake others for a family member? For example, someone with similar hair or height?
- How does your child recognize people around them? Hair color/shape, height, gate, clothing, shoes, glasses, voice?
These days, I marvel at all the compensatory strategies my kid uses to make it through an unrecognizable visual world. He’ll rummage through the snack cabinet, shake the boxes of cereal and crackers, until he finds the one that sounds just right. He’ll ask who just sat down at the table or pull out something from the fridge and ask, “What is this?” He’ll touch all of the food on his plate until he knows everything that is there.
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.
The main goal of accommodations and adaptations for CVI is access to learning. Recognition equals learning, and learning is not only accomplished visually. But it can be incredibly fatiguing for people with CVI trying to figure out unrecognizable items or environments without the necessary adaptations and supports. Many with CVI need strategic teaching methodologies, visual adaptations, and opportunities to use other sensory channels (auditory, kinesthetic, and/or tactile) to support understanding and concept development.
Remember, vision is not reliable 24/7, so what accommodations and adaptations are required for the student with CVI to access their learning throughout the entire day? Supports are also not a hierarchy, meaning visual accommodations are not the be-all-end-all for some with CVI, sometimes tactile and auditory supports need to take the lead. It’s about balance and what works best for the individualized needs of the person with CVI.
Adapt the learning environment
- Maintain a predictable and organized environment. Having a well-organized learning space supports environmental mapping and consistency.
- Reduce visual clutter in the learning space. For example, use a black trifold to create a clean background when presenting learning materials or find a learning space that has at least two blank walls so the background clutter does not interfere with trying to visually attend to the learning material.
- Reduce noise and distracting light (overhead, from windows) and movement (high traffic areas, peers passing by, or working in a group nearby).
- Supportive positioning: Your child should be fully physically supported for learning tasks and activities. This may include a wheelchair, stander, or any other equipment adaptations required (armrests, footrests, stool) and in any other position deemed safe by your physical therapist and occupational therapist.
- Leverage color and contrast. Use bright, bold colors to support visual attention and recognition of landmarks in the environment. The incorporation of color should be strategic as adding too much color to the environment can increase the impact of crowding. For example, bright blue tape around the rim of a container, green tape on handrails, or yellow on the student’s chair. Make sure color is used to support increased contrast to help the target pop and stand out. Have landmarks be accessible at the student’s eye level.
Adapt the learning task
- Know the most accessible learning media. For some with CVI, they are only able to visually recognize real objects, for others they can also recognize familiar pictures, photographs, and print. But even processing two-dimensional materials for too long can be fatiguing for many with CVI. What type of learning material is most accessible? Is it images? Print? Enlarged print? Tactile symbols? Braille? A combination? It’s important to remember the other sensory channels for learning (auditory, kinesthetic, tactile) and the needs related to the task so the student can have full access to their learning at all times.
- Reduce visual clutter and crowding. Simultaneous visual information may disrupt visual recognition. If the learning task includes the use of vision, make sure items are presented either one at a time or with the number of items that is the assessed threshold for the student. For example, no more than three at a time. Understanding the optimal spacing, font style, and size is critical when considering access and skill maintenance. Presentation is typically task-dependent.
- Leverage color and contrast. Color coding is a strong support and compensatory strategy for visual recognition. For example, color-coding symbols and numerals in math problems may reduce the visual search for important information, help follow along when solving an equation, and recognize the parts of the equation when vision use becomes difficult. Color can also support recognizing details on an object or in a photograph. Make sure color supports increased contrast to help the target pop and stand out. Again, this should be supported by individualized assessment.
- Intentional use of light. Use backlit devices or task lighting to support visual attention and recognition. For example, shine a flashlight on an item presented with other items to support initial focus. For some with CVI, a tablet offers backlighting to support visual attention and recognition of two-dimensional pictures and images, for others, it makes no discernible difference. Remember, some with CVI have light sensitivity, so too much light can be uncomfortable and fatiguing.
- Consider the impact of motion. Sometimes, slow methodical movement of an object can support visual attention and recognition. For some, slow movement of an image on a tablet can help them process and recognize it. For others, self-movement can help provide a sense of seeing and support processing visual input.
- Present materials in accessible visual fields. Does your child see best at left, right, or central? Place items on a slant board with a magnet or velcro board if your child has difficulty with their lower visual field. Raise items to eye level using a dark color plain box. Learning materials should be positioned in the most accessible visual field (right, left, upper, lower)—use assistive items (i.e., slant board, book stand, tablet stand). Encouraging your child to turn their head to locate information in inaccessible visual fields is a great compensatory strategy.
- Allow the student to focus on one task at a time (i.e., writing, listening, or speaking). If they need to listen, expect them only to listen. If they need to look at something, do not expect them to listen also. Offer a prompt, then stop talking and observe the student’s actions. Again, this is an area for ongoing assessment and evaluation.
- Provide wait time. Allow time [based on assessment results and task demand] for your child to establish visual attention, to visually recognize, and to physically or verbally respond. Even after looking, processing what is seen may require more time. Know that the person with CVI may require additional time to process visual information in new, noisy, and/or busy environments; the degree of required pause time for response will directly correlate to the visual demands of the task, materials, and/or the environment.
Full access to learning (because vision is not reliable 24/7)
- 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. Use real objects, manipulatives, experience stories, active learning approaches, story boxes, and hands-on activities. Using multiple methods of access supports recognition. Our sensory systems are highly interconnected, so when we can feel, listen, move, and fully experience something we can build more pathways to perception and understanding.
- Direct and explicit instruction to develop rich concepts in all areas of learning. Many foundational skills for literacy and numeracy come from being able to visually recognize the surrounding environment (incidental learning). Educators and providers must provide direct instruction in all the skills and concepts needed to master a learning goal. When teaching new concepts, connect them to familiar items and experiences. Repetition and familiarity are foundational to instructional approaches for students with CVI.
- Create a strong sensory foundation for concepts in the natural environment (people, objects, actions, and places) to ensure that communication symbols (tangible, auditory, visual) about these concepts are meaningful. Link sounds and tactile input to visual events. Use language and hands-on involvement to connect sensory experiences, help build connections, and label events, feelings, and situations.
- Autonomy, choice, and advocacy. Create systems that scaffold self-advocacy and support agency for the student. Provide choices for how they want to consume the information, apply their skills, and show what they want to know. Making space for choice and autonomy means having multiple supports and access points at the ready. We have to evolve with the student, observe constantly, and collect data. We have to always reexamine the environment, instructional approach, and learning tasks and materials.
Find more examples from a guide to common CVI IEP accommodations in the CVI Now IEP Guide.
You don’t perceive objects as they are. You perceive them as you are.
David Eagleman, Livewired: The Inside Story of the Ever-Changing Brain
Following the science
Connecting current research of 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 results from 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.
- 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.
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