Article
How can literacy instruction be adapted for students with CVI? Two case studies
Two students with CVI, two individualized paths: How Karen Barrows adapted literacy instruction to meet each learner’s needs.
CVI Now sat down with Karen Barrows, DPT, M.Ed., MHS, and a TVI at Perkins, to discuss the literacy journeys of two of her students with CVI. Each of her students accesses literacy in their own individualized way. Learn about how Karen used an assessment-driven, systematic, and student-centered approach to support literacy skill development and growth.
Jump to:
- Student A – From struggling to identify letters to reading chapter books
- Student B – A tactile path to language and connection
Student A – From struggling to identify letters to reading chapter books
Background
Student A is 10 years old and has CVI, learning disabilities (including suspected dyslexia), and auditory processing concerns. The student arrived at Perkins two years ago with limited letter recognition, phonemic awareness, and reading comprehension skills. Student A is a dual-media learner using visual and auditory channels to access literacy.
Some of the findings from the CVI and learning media assessments:
- Low tolerance for visual clutter. Student A becomes visually overloaded when presented with busy pages, multiple lines of text, or materials with insufficient white space.
- Responds well to color-coded materials. Showed a strong preference for certain high-contrast combinations, for example bright yellow on black and bold blue on white.
- Light is fatiguing. Student A becomes noticeably more visually fatigued and develops headaches in environments with bright or fluorescent lighting. Prefers lights off with task lighting on learning materials.
- Needs extended processing time both visual and auditory.
- Large print, 18-40 pt font depending on tasks.
Clutter was a big barrier to access. That’s why it took a long time to get to a chapter book, because now you have a bunch of words all on one page. We started with a few words at a time, then sentences, to paragraphs, and to passages. All the while adapting for visual access and reduced fatigue.
-Karen Barrows, DPT, M.Ed., TVI, MHS
Systematic, individualized approach
- Reading intervention program: Student A’s instruction began with a structured, systematic approach to phonics and decoding through the Wilson Reading System. Karen conducted the Wilson Assessment of Decoding and Encoding (WADE), an entry assessment tool for the Wilson Reading System.
- Flexible pacing: Each Wilson step required a tailored pace. Some steps took only a week; others spanned months. One particularly challenging step lasted nearly two months. Proactive breaks and sensory supports are also built into the direct service session and throughout the day.
- Multisensory approach: Karen experimented with various modalities to meet the student’s needs at every step, for example, dry-erase markers and white board, magnetic tiles, manipulatives, audio, and large-format visuals. Drawing on the white board was a scaffold for building comprehension skills. Flexibility and patience were essential, along with ongoing data collection.
- Audio books and digital tools: Student A used an iPad customized with visual modifications (color, inversion, magnification). Bookshare allowed the student to access audiobooks with synchronized highlighted text. Karen slowed the audio speed to accommodate the student’s processing, although even the slowest setting sometimes proved too fast.
- Accessible environment: Quiet room with overhead lights off and task lighting on learning materials. Student A also began wearing tinted glasses and a hat to help reduce the effect of overhead lighting on visual fatigue.
- Large print: 18 point font size was the student’s baseline, with adjustments depending on visual fatigue (up to 40 pt).
- Intentional use of color: Student A prefers blue text on white, but also benefits from high-contrast combinations like bright yellow on black or white on black—particularly when using the video magnifier.
- Tools to reduce and navigate clutter: At the beginning of their work together, Karen minimized clutter and increased spacing between text. Over time, Student A became more comfortable with multiple lines of text presented at once. Occluders (e.g., black construction paper to block out excess text and clutter) and line guides help Student A orient and track multiple lines of text. The student now uses line guides, their finger, or a pencil as a guide independently.
- Accessible visual field: Use of a slant board to bring learning materials into accessible fields.
- Independence building: Student A now begins each session by setting up their environment—adjusting lighting, pulling out tools, and preparing their materials.
I have constantly been looking at [Student A] and trialing things from day one, with the goal of building their independence. Now [Student A] sets up their own accommodations, chooses their tools, and takes ownership of their learning.
-Karen Barrows, DPT, M.Ed., TVI, MHS
Comprehension breakthroughs
As Student A advanced in decoding and fluency, comprehension became a clear obstacle. Initial comprehension assessments—both auditory and print reading—showed minimal understanding. Based on a recommendation from a literacy specialist, Karen had Student A start drawing what they read, and things started to connect. During a Wilson story about sledding, Student A illustrated the events on a whiteboard. Prompted step-by-step, the student drew the characters, setting, and sequence of events, revealing a strong level of comprehension.
Over time, this scaffolding coupled with prompting and explicit questioning transitioned into higher-level strategies: rereading passages, locating and citing textual evidence, and making personal connections to characters or events to strengthen understanding. Today, Student A no longer needs to draw to comprehend, but it proved to be a strong scaffold to building comprehension skills.
From reluctant to enthusiastic reader
Once disengaged from reading, Student A is now an avid reader. They read chapter books—yes, grade-level chapter books! While not fully independent at that level, Karen and the student use them to build fluency, expand vocabulary, and develop endurance. The student still prefers physical books over reading on a screen and uses Bookshare when needed for longer texts, additional exposure, or fatigue management.
Student A reads books independently and logs progress on a book chart. During a recent summer break, the student read six books with their mom. Reading now as a source of pride for the student.
This student’s growth is an example of how intentional, individualized instruction can support building literacy skills. Their journey underscores the importance of multi-sensory, scaffolded literacy instruction, responsive assessment-driven accommodations, ongoing data collection, a flexible and adaptive approach, collaborative problem-solving, and student agency and voice.
[Student A] went from a kid who hated reading, hated doing it, to a kid who whipped through six books in one summer. [The student] just got super, super excited about reading.
-Karen Barrows, DPT, M.Ed., TVI, MHS
Student B: A tactile path to language and connection
Background
Student B is 11 years old and a vibrant, curious learner who experienced a significant stroke near birth. The student has CVI and neurodevelopmental conditions, and arrived at Perkins a few years ago with emerging literacy skills and difficulty recognizing print-based literacy materials. Before Perkins, the student had limited access to non-visual tools and approaches to learn how to read. Now, Student B is a dual-media learner using tactile and auditory channels to access literacy.
Some of the findings from CVI and learning media assessments:
- Able to use vision in central field in left eye with materials 1-2 inches away
- Recognizes bright bold colors
- Difficulty with consistent access to print, even in large, high-contrast formats
- Functional vision assessments noted ability to detect motion and color but emphasized that vision could not be relied upon for literacy tasks
- Strong tactile preferences and exploratory behaviors, able to gain information from handling materials and objects, and the beginnings of tactile discrimination skills
- Responded well to auditory input and remembered keywords from repeated songs and spoken stories
- Showed phonemic awareness skills.
- Observations revealed minimal verbal communication and reluctance to participate in learning activities
- A braille-based literacy approach would best match the student’s needs, especially one tailored to his strengths in tactile learning, auditory processing, and kinesthetic engagement
Systematic, individualized approach
- Structured, student-centered method for teaching braille: Karen uses I-M-ABLE: Individualized Meaning-Centered Approach to Braille Literacy Education, a method that places a student’s interests and capabilities at the center of instruction, fostering literacy through real-life experience and emotional connection.
- Building tactile skills: Student B had difficulty isolating his fingers. Karen asked the team to incorporate building fine motor and finger isolation skills into their work with the student—both the OT and music therapist worked on these skills.
- Pre-braille box: Karen used various materials from her pre-braille box to build braille concepts and tactile discrimination. This included a muffin tin with different textured balls, embossed material, and a swing braille cell (supported transition from knowing the dots in a braille cell to using the braille writer).
- Kinesthetic and full body activities to help understand braille and literacy concepts, and now is used for warm-up activities. For example, stepping or dancing out a braille letter on the floor and feeling six large braille “dots” on the wall (all different colors and textures) to identify the dot code for each letter.
- Adapted braille writer: Karen added different texture on the braille keys and used a finger guide to help Student B choose the correct keys. Created on a 3D printer, the finger guide includes plastic partitions between braille keys. This served as a scaffold and Student B no longer needs these guides.
- Whole-word approach prioritizing meaningful vocabulary: As Student B learns the braille alphabet, instruction also begins with whole, meaningful words that matter to Student B, such as relax, snacks, play.
- Word-finding and recognition: Karen does several structured activities to build Student B’s braille reading skills. For example, she embeds one of the core vocabulary words with lead-in and lead-out lines for Student B to find, recognize, and read. As Student B became better at identifying the words, Karen then embedded them in simple sentences. For example, “[Student B] likes to play with puzzles.” The name, “play,” and “puzzle” are Student B’s known keywords. Karen read the words “likes to” and “with.” Any time Student B reaches the practiced keywords, the student reads clearly and proudly. This shared reading encourages motivation to read and get exposure to new words.
- Team collaboration and literacy in daily life: Karen shares Student B’s core vocabulary list with the classroom staff and the parents, sending home a copy of every word sheet they work on. Daily routines involve braille interactions, such as using cards with braille and tangible symbols and braille labels throughout the classroom. Student B is now learning to label items in the home and working toward helping with chores.
[Student B] knows 16 keywords now. I’ve approached his braille instruction in a complete multisensory manner. He loves to explore and touch things and he also loves to move his body. So we use a tactile and kinesthetic approach. I have a big, huge Braille cell on the wall with big circles each with a different texture and color. I say, ‘What’s the letter M? An elbow there? A hand here? A knee there? There’s a letter M.
-Karen Barrows, DPT, M.Ed., TVI, MHS
Growth in skills, confidence, and joy
Student B now recognizes and reads 16 braille words at various levels of independence. Student B’s tactile tracking has improved significantly, and the student now seeks out braille labels independently. Beyond skill development, Student B continues to grow in confidence, motivation, and expressive language. Student B has totally opened up and now talks nonstop. The team sees Student B light up when recognizing a word, and the student now initiates reading interactions with peers and adults. Student B frequently names familiar braille words out loud, asks for braille books during free time, and proudly reads braille and tangible cards to their teachers. Student B has even begun inventing their own “Braille messages” using the Perkins Brailler, narrating what they are typing as they go. Literacy is now a joyful and empowering experience.
In the time that [the student has] been here, we had a completely different [Student B] at the start. Now the student talks all the time. Says things like, ‘Hey, Karen, this is my friend. We’re playing with… We’re doing this… And what do you think?’ [Student B] is a hard worker and so full of joy.
-Karen Barrows, DPT, M.Ed., TVI, MHS
Student B’s literacy journey illustrates the power of a strengths-based, tactile-first approach. By focusing on meaning, connection, and life experiences, Student B’s team created a pathway where braille literacy is not just accessible—it’s exciting. Karen’s thoughtful and systematic approach has not only opened the door to reading but has empowered this student to find their voice and agency.
All approaches, tools, and sensory channels should be available for students with CVI. It’s about access to learning. Most with CVI are dual-media learners, for example tactile and auditory, visual and tactile, or auditory and visual. When it comes to access to literacy for students with CVI, there is no one-size-fits-all approach. It must be assessment-driven, student-centered, and systematic.
