CVI for Orientation and Mobility Specialists (O&Ms)

Written by: Juli Greenleaf, M.Ed, TVI/COMS

What is CVI?

Cerebral/cortical visual impairment (CVI) is a brain-based visual impairment caused by damage or interruption to the visual processing areas of the brain. With CVI, the brain has difficulty recognizing and making sense of the visual world. CVI impacts every aspect of life. The CVI visual behaviors are a framework for understanding the impact of CVI on access and is rooted in current CVI research.

CVI is the leading cause of childhood blindness and low vision, but it is alarmingly underdiagnosed. Less than 20% of kids in the US have a CVI diagnosis. CVI often co-occurs with neurological, neurodevelopmental, or genetic conditions. Those with healthy eyes and without other conditions can still have CVI.

How might CVI impact orientation and mobility (O&M)?

CVI can impact an individual’s ability to gather visual information about their surroundings as they are moving through space. The rate of the speed the individual is traveling, as well as whether the objects in their travel space are moving or stationary, can impact how an individual visually interprets their surroundings.

Individuals may at times appear to be clumsy, knocking over or tripping over objects. They can appear to get lost easily with familiar routes, facing challenges traveling around the school. The student may have difficulty getting between classes when there are a lot of people in the hallways, but may not have the same difficulty with navigation when the hallways are empty. Even within the classroom, they may face challenges locating their desk on a daily basis. If their desk has been moved in the classroom, they may no longer be able to locate their desk.

Ensuring safe navigation in all settings and environments for students with CVI is paramount.

When might you suspect a student has CVI within your work as an orientation and mobility specialist?

CVI has diverse manifestations, and we know no two individuals with CVI are exactly alike. Here some examples of indicators and observations that might lead to suspecting CVI:

Trips over objects on the floor in the classroom or hallway
Struggles to traveling familiar routes (and be able to reverse a route) in the school or the community (locating desk in classroom, difficulty traveling between 2 locations in the school building)
Difficulty using playground equipment—walks too closely to the swings, won’t leave the side of an adult on the playground, plays only on even terrain areas, stays close to playground boundaries, or is nervous and hesitant on playground equipment
Hesitant on surface changes—toe taps or uses hands to feel visual surface changes (i.e.grass to sidewalk, carpet to tile, etc.)
Trouble with changes in depth—unwilling to go up and down stairs, curbs, or ramps, relies on railing, drags their heel when going steps, toe taps to check if there are any more steps, over or under steps at curbs, ramps, or stairs, or hesitant to go up or down a ramp
Has a hard time recognizing and locating familiar people
Difficulty traveling in crowded or unfamiliar places (holds someone’s hand, cart, following behind people)
Difficulty with directional concepts and reading or following visual maps; May only rely on landmarks or nonvisual clues to navigate a route

Boy walks outside on a wooded path with his walker

Learn more about when to suspect CVI.

What strategies and approaches might be helpful to use in O&M with students with CVI?

All interventions, instructional approaches, and accommodations must be driven by comprehensive assessment that meet the student’s individual needs to access learning and the environment. Below are a few ideas to inspire inquiry.

Conduct an O&M assessment using a CVI lens over several sessions to see the student in various environments and, ideally, on different days and times to account for potential visual fatigue or other factors that may impact the student’s abilities (e.g., ill, tired, overwhelmed by sensory input). Learn more about CVI O&M assessment strategies.
Use of non-visual sensory channels to support navigation and need for visual breaks.
Preview locations before the student experiences a certain location. Preview strategies may include:
- Use photographs or videos to zoom in on landmarks, seats that could be available or learning paths between a door and target area (like a check-in desk).
- Videos of the student traveling through the environment, so they are able to review a location where they traveled.
- Tactile maps to preview the layout and space.
- Verbal descriptions of the location with objects to support concept development and meaningful language.
Schedule travel during quiet, off times. When learning new routes at the school, make sure hallways are quiet to minimize distractions. When doing off-campus outings, try to select times based on sun and when stores/streets are the least busy to minimize distractions.

Instructional adaptations and materials

Simple and reduced cluttered pictures of landmarks
Preview new locations and/or routes through pictures, video, verbal description, or tactile methods.
Practice routes during less busy times, for example, empty hallways, outside navigation that is away from crowds and noise.
Back mapping or haptic for teaching routes. Back mapping or haptic mapping use the sense of touch where someone uses their hand on the back of the individual to draw a map of the location.
Descriptive narration of activities and environment
Hat with a brim, sunglasses, or visual occluders
Assistive technology and apps for navigation, identifying currency, scanning for optical character recognition, speech-to-text
Mobility aids like a white cane or pre-cane
Maps in the appropriate format, e.g., tactile, 3D, acoustic, Wheatley, online, etc.
Encourage others to say the student’s name and identify themselves when beginning a conversation.

Environmental adaptations

CVIer Bruce walks along a bridge using his white cane.

Provide color highlighting for desk or cubby, automatic door button, door handles, soap, hand dryer, etc
Color highlighting of landmarks or signs
Keep floor clear of backpacks.
Color highlighting of safety areas on playground
Color highlighting of curbs, stairs, ramps, playground boundaries
Keep things in their place (or tell student when things have been moved).
Tactile markers on landmarks, signs, or important spaces in the classroom
Preferential seating, permission to move around the room, extra desk space, personal cubby or locker
Be conscious of the impact of light coming through a window and spotlighting the floor, which may cause anxiety for the student crossing over it.

Collaboration ideas

Collaboration is key to the success O&M skill use throughout the day!

Closely collaborate with TVI during assessment and evaluation process and IEP development.
Work with PT on curb and/or stairs to check for stability (motor versus vision) when walking up and down stairs as well as head position when walking up and down stairs.
Work with school staff on adapting classroom and school areas such as locating a desk, cubby to store their backpack, keeping things in the same spot, finding familiar locations (classroom, restroom, office, etc.). Show staff how to store mobility aids, such as a white cane, and how to be a sighted guide as needed while navigating school or the community.
Work with team on using consistent directions to locate information, such as using prepositional words when describing locations.
Work with PE on adapting games/activities (slowing down a ball, using high contrast materials).

Dive into our 4-part part series on CVI and O&M:

Note to readers: This article is meant as an overview and brief introduction to CVI, a deep and complex condition with diverse manifestations. It is important to remember that all children with CVI have different needs. The recommendations and suggestions are ideas for a starting point. There is not one size fits all approach for CVI, and interventions and strategies must be match to the student’s individualized needs and comprehensive assessment results.

Explore CVI overviews for various disciplines in our CVI Educator Toolbox.
Visit the CVI Now Educator Hub

Juli Greenleaf, M.Ed, TVI/COMS
Juli has been working in Special Education for 18 years. Currently she works in Georgia as a TVI/Coms working with kids birth to age 22. Juli has a Masters Degree in Special Education from Texas Tech University along with Graduate Certificates in the following areas: Orientation and Mobility, Dual Sensory Impairment, Sensory Impairment and Autism Spectrum Disorders, and Visual Impairments. She has also completed the UMass at Boston graduate Certificate in Cortical/Cerebral Visual Impairment. She is currently working on her doctorate through Texas Tech University with a focus on Orientation and Mobility for kids with CVI.