Getting started with CVI assessments

A young girl sitting with a female teacher

Getting proper CVI assessments and evaluations for your child might seem overwhelming. Are you doing enough? Who handles what? Here’s a thorough primer on what needs to happen once your child is diagnosed with Cerebral/Cortical Visual Impairment (CVI), derived from your child’s CVI visual behaviors.

The role and responsibility of the teacher of the visually impaired (TVI) is to lead your child’s educational team by sharing essential information from specialized assessments and to assist in the development of the Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). TVIs should conduct:

a functional vision assessment
a learning media assessment
an environmental assessment

Each of these assessments examines the visual and behavioral features of CVI that uniquely impact your child. The goal is to integrate these findings into the whole picture of your child’s educational needs. Collectively, these assessments provide information that’s needed for successful program planning, intervention, environmental changes and service delivery.

Understanding your child’s functional vision assessment

The ocular functional visual assessment (FVA) looks at any possible eye conditions that might also be impacting some children with CVI. This is an additional consideration for how well your child uses his vision to perform everyday tasks. It evaluates how and what your child’s eyes see and what supports will create better access to the visual world. It’s conducted by a TVI, who specializes in evaluating kids with CVI and who can consider the impact of both ocular and cerebral/cortical difficulties. It targets the impact of ocular, not neurological, impairments.

A TVI must understand that traditional ocular assessments are unlikely to adequately assess the unique aspects of functional vision that are indicative of CVI, and therefore must use CVI specific tools to evaluate the impact of CVI on functional vision. Your TVI should:

Include a review of ophthalmology and neurology reports with an eye toward how your child will learn best.
Understand that acuity measures are only part of the criteria for visual functioning in learners with CVI.
Partner with medical, educational and related service professionals to determine if your child has an ocular impairment that could also impact his functional vision.
Understand the central role of parents in assessment.
Understand how your child is using his compensatory skills (i.e., memory and motor-planning) and other non-visual strategies.
Lead the FVA and collaborate with primary team members (including you!). Such collaboration is essential to develop a full understanding of how your child functions across environments and throughout the school day. Collaboration is important to ensure that assessments by other educational team members are adapted appropriately to meet your child’s unique visual needs.
Complete and interpret all findings of the FVA and vision function assessment (i.e., as provided by an eye care professional).
Consider application of assessment findings within the framework of the Expanded Core Curriculum (ECC) in terms of the impact on your child’s functioning at all stages of development. This is especially important, as the ECC is a unique expertise and responsibility of vision educators.

When conducting the FVA, your child’s TVI must gather data from a variety of perspectives in order to fully understand her needs. The teacher must understand the ocular conditions and conditions that may lead to a diagnosis of CVI. Valuable data points when completing the FVA include:

Review of your child’s medical (including neurological) and visual history.
Direct interviews with parents, teachers, therapists and your child (if applicable).
Direct observations in the classroom, community and natural environments including familiar and unfamiliar environments.
Direct assessment of your child in an adapted environment with examination of her unique visual behaviors that are specifically related to the functional use of vision. In this adapted environment, children often show us their optimal visual abilities.

Understanding your child’s learning media assessment

Your TVI must also complete a Learning Media Assessment (LMA) to evaluate media needs (visual, tactile and auditory) and sensory preferences for your child. The TVI will understand how information gleaned from the FVA should inform how the LMA is conducted. This assessment should be administered simultaneously each time an FVA is administered, due to the fact that the primary learning media modality may change at different stages of development in kids with CVI. The LMA results must be considered in the context of possible visual change. The results often direct instruction towards multisensory media learning: employing learning through hearing; learning through touch; learning through smell; and learning through vision.

Here are some CVI specific tools:

The Perkins CVI Protocol^SM is a comprehensive and inclusive educational assessment tool for students with Cerebral/Cortical Visual Impairment (CVI), created by The CVI Center at Perkins. The CVI Protocol is built on the current research and understanding of CVI, and is a methodical assessment of a student’s CVI visual behaviors and compensatory skill use. This evaluation tool is designed to help teachers of the visually impaired create a robust, individualized CVI evaluation report with recommendations for students with CVI. The Protocol is free, downloadable, customizable, and grounded in science.
Dr. Gordon Dutton’s Visual Skills Inventory: Provides a framework for parent interview questions around your child’s visual attention, visual field function, attention to light, distance attention, visually based interactions with people, perception of movement, difficulties with visual complexity that might cause behaviors in complex environments, difficulties handling additional sensory information, difficulties with visually guided movement (of reaching and stepping) and difficulties with visual recognition.
Teach CVI Screening Tools: Using the TEACH CVI Screening provides questioning for the CVI indicators of visual attention, visual field function, attention to light, distance attention, visually-based interactions with people, perception of movement, difficulties with visual complexity that might cause behaviors in complex environments, difficulties handling additional sensory information, difficulties with visually guided movement (of reaching and stepping) and difficulties with visual recognition.
The Visual Assessment Scale (VAS CVI-PIMD) by Marjolein Wallroth and Marieke Steendam is a tool that evaluates the visual functioning of children with multiple disabilities and includes an inventory and caregiver questionnaire. The brain-based visual behaviors identified for assessment are visual attention, reaction to light, visual curiosity, visually-based social interactions, handling multisensory information, difficulties in visual motor skills (upper limbs), visual fatigue, orientation and mobility, speed of visual processing, variable vision use, and difficulties with visual recognition.
Considerations for Educating Students With CVI: The Learning Environment by Amy Campbell, Deborah Chen, and Marieke Steendam. “This tool facilitates team discussion and problem-solving, and offers practical ideas to implement throughout the school day, with the intent to promote a student’s access to instruction in a positive learning environment.” The tool covers five areas: Student Preferences, Communication, Peer Interaction, Task Complexity, and Environmental Complexity. Within each area, there are a list of questions and some suggestion to consider to help the school team gather information about the student, think deeply about accessibility throughout the school day, support the transition to a new educational setting, facilitate changes to the learning environment based on student needs, and determine the possible need for additional assessment. Download the PDF in English, Spanish, or Portuguese.
Christine Roman-Lantzy’s CVI Range: Evaluates functional vision in relation to 10 visual and behavioral characteristics: color preference, visual latency, need for movement, difficulty with novelty, visual field preferences, complexity (array, objects, faces, environment), difficulty with distance viewing, need for light, atypical visual reflexes, and difficulty with visually guided reach. Roman-Lantzy’s CVI Range uses a scale of 0-10 to score and measure functional vision of an individual with CVI, with 0 indicating no visual response and 10 being almost typical vision.
Matt Tietjen’s 2D Image Assessment: Evaluates what your child’s most accessible two-dimensional images are for learning. The assessment helps to determine whether photographs, drawings, colored forms, iconic or symbolic pictures are the best recognized.
Matt Tietjen’s “What’s the Complexity?” Framework: An assessment that looks at the complexity of the learning materials and at the complexity of the environment that are the most accessible for learning. It helps balance the learning material accessibility with the environmental accessibility.

Why environmental assessments matter

The TVI, with an orientation and mobility (O&M) specialist, must also complete environmental assessments to evaluate the environment’s impact on your child’s learning and to determine which supports will help your child to move through her world safely. Information from the FVA and LMA will inform the environmental assessment and should be shared with your child’s educational team, along with other assessment results. This assessment determines possible environmental modifications to your child’s surroundings and learning materials as well as those for O&M. For example, the environmental assessment must take into consideration your child’s experience related to sound, sight and safety.

These assessments can each go a long way toward making sure that your child gets the support she needs, tailored just for her.

Learn more about assessment and accessible learning

References:

Dutton, Gordon, N. “Assessment of Functional Vision: History Taking for Children with CVI”. Contained in A. Lueck & G. Dutton: Editors, Vision and the Brain: Understanding Cerebral Visual Impairment in Children. 2015, New York, New York: American Foundation for the Blind Press. Chapter 11

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

Roman-Lantzy, C. and Tietjen, M. (2020). Sensory Balance: An Approach to Learning Media Planning for Students with CVI. Watertown, MA: Perkins School for the Blind.

Teach CVI (2017). Screening lists for children with suspicion of CVI. Retrieved from: https://www.teachcvi.net/screening-tools

Tietjen, M. (2019). The “What’s the Complexity?” Framework. In Roman-Lantzy, Christine. (2019) Cortical Visual Impairment: Advanced Principles (pp. 92-150). Louisville, KY: APH Press