Tips and facts
CVI for Speech-Language Pathologists (SLPs)
A brief overview of CVI for SLPs. Learn how CVI impacts evaluation and intervention, and ideas for starting points.
Written by: Sylvia Mangan, MS CCC-SLP, CCVI
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 speech therapy?
- CVI can significantly impact a student’s social skills, as they often have difficulty with facial recognition, understanding facial expressions, and interpreting the movement of body language.
- CVI can also impact a student’s ability to access literacy materials and visuals, as they may have difficulty recognizing anything in 2D, or more abstract picture representations (like Mayer-Johnson pictures, or children’s book illustrations).
- CVI may affect a student’s ability to build vocabulary, as they often have difficulty looking and listening at the same time or processing multiple sources of sensory input (sound, vision, touch, internal sensations).
When might you suspect a student has CVI within your work in speech therapy?
CVI has diverse manifestations, and no two individuals with CVI are exactly alike. Here some examples of indicators and observations that might lead to suspecting CVI.
- Avoiding eye contact or difficulty looking at faces
- Looking at lights, windows, or fans, rather than the materials you’re using
- Looking away while reaching out for toys or Augmentative-Alternative Communication (AAC) supports
- Accessing their AAC supports easily in a quiet and organized speech therapy room, but struggling to use them in a noisy cafeteria or cluttered resource room
- Using their AAC device easily at the beginning of the session, but struggling as they grow fatigued (rubbing their eyes, looking away)
- Standardized assessment of vocabulary and receptive language appears to be a low estimate of skills (perhaps due to difficulty accessing pictures in assessment)
Learn more about when to suspect CVI.
What strategies and interventions might be helpful when working 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.
Overall, let the student lead your practice! Their total communication and body language will show you when they are fatigued, frustrated, or overstimulated and overwhelmed. Their behavior is communication—if they appear frustrated, try some of the following adaptations to alleviate their stress and help them succeed.
Instructional adaptations
- Many children with CVI will not be able to look at your face or a mirror when you model speech sounds. Use tactile cues, auditory feedback and bombardment, physical models, and other methods, instead.
- Instead of teaching facial expressions visually, focus on compensatory skills for social access, like recognizing tone of voice and sarcasm.
- They may need to have one sense challenged at a time—look first in silence, then listen to a label or description.
- Collaborate closely with the TVI when designing and implementing AAC systems, and always match your system to their assessment recommendations.
- Design an AAC system that primarily uses the student’s strongest sense (vision, touch, or auditory). TVIs identify this in their Learning Media Assessment.
- If using a visual system, when first introducing vocabulary, consider masking all the icons that you are not targeting in a specific activity. Reducing clutter can support access until compensatory skills kick in (muscle memory, auditory fishing, etc.).
- Avoid using too many colored borders and select icons with minimal clutter whenever possible.
- Consider implementing supplementary AAC systems (sign language, visual-tangible symbols, a more limited array vocabulary, word approximations, etc.) to help the student communicate in loud or cluttered environments where their vision is less effective.
Environmental adaptations
- Reduce clutter in your environment. If you need to have posters and visuals up on the wall, face your student with CVI away from them or put up a black trifold board so that they don’t have to see clutter.
- Keep the environment quiet. Many individuals with CVI need to process just one sense at a time—so reduce background noise whenever possible.
- Control the lighting in the environment (lamps, blackout curtains, task lighting). Your student may need to face away from bright light sources or have thoughtful use of light to draw their attention to your materials.
Collaboration ideas
- SLPs and TVIs have the same goal of universal access for our students! Your values align, but sometimes your path to get there differs. Keep the common values in mind as you find ways to work together.
- Consider partnering with TVIs on your assessments.
- Attend the TVIs assessments so that you can model AAC systems or clarify any miscommunications.
- Invite the TVI into your speech and language assessments so that they can look at maximizing the accessibility of your assessment materials.
- Most importantly—debrief together afterwards, and share your opinions openly, thoughtfully, and respectfully.
- Have a shared drive of some kind (Google Drive, Google Photos, Dropbox, Slack, etc.), where you upload photos, videos, resources, and more to share with each other and collaborate on joint projects or routines.
- Push into each other’s contexts for direct services! Co-treat and learn from each other as you do so.
Resources on CVI
- CVI, complex communication needs, and AAC: What a webinar full of case study examples and find other resources
- 5 Essential steps for finding the best AAC system for a learner with CVI
- Assessing 2D image recognition for students with CVI
- Getting started with CVI assessments
Note to readers: This article is meant as an overview and brief introduction to CVI, a deep and complex condition with diverse manifestions. 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.
Sylvia Mangan, MS CCC-SLP, CCVI
Sylvia is a CVI Coordinator Supervisor in the CVI Center at Perkins School for the Blind. She began her career as a Speech-Language Pathologist, and completed her education at Northwestern University. She worked in public schools before joining the team at Perkins. She developed a passion for working with students with multiple disabilities, including CVI, with a special interest in supporting individuals with complex communication needs. She completed the CVI Certificate from University of Massachusetts, Boston, and is completing her degree as Teacher of the Visually Impaired from the same institution. She has taught graduate level courses and enjoys speaking at conferences on supporting the unique learning profile of this demographic and amplifying their voices.
