CVI for Teaching Assistants and Paraprofessionals

Written by: Nicole Homerin, M.Ed

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 your work as a paraprofessional or teaching assistant (TA)?

As a paraprofessional or TA, you may be responsible for supporting learning for students with CVI in 1:1, small group, and whole classroom activities. Understanding how CVI manifests in the students you work with can help you ensure they have access to their learning and environment. You may be asked to make adaptations on the fly for an inaccessible worksheet or help implement proactive breaks to help reduce visual fatigue. There also might be times where you are working with a student where you observe they aren’t quite using their vision in a typical way and have repeated struggles with school tasks. It’s important to know what to look for and who to talk to if you suspect one of your students may have CVI.

When might you suspect a student has CVI within your work as a paraprofessional or TA?

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.

Frequently disengages with learning materials (e.g. closes their eyes, falls asleep, demonstrates signs of sensory overload, swipes materials off the table)
Trouble finding or identifying familiar classroom materials/objects in the classroom environment
Difficulty navigating the classroom and school environment, and needs support to find certain classrooms or their school bus at the end of the day
Difficulty recognizing familiar people and faces (friends, teachers, family members); Not knowing who is around them all the time

Jeremiah looks at a photo/tangible tile that represents himself and holds his palm against the tactile element.

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. Below are a few ideas to inspire inquiry.

Instructional adaptations

Wait time: It may take individuals with CVI longer periods of time to visually attend to, fixate, and/or visually recognize an item. This is known as the response interval, one of 16 visual behaviors associated with CVI. When working with a student with CVI, you may need to provide extended wait time between prompts or a response from the student.
Use multisensory materials: Functional vision, or vision needed to participate in daily activities, may fluctuate for students with CVI throughout the day. In addition, some students may experience visual fatigue that may make it hard for them to use their vision to engage in learning. Incorporating multisensory approaches to learning allows for students to use other senses (touch, hearing, movement) to gain information and understanding. For example, use real objects and manipulatives, story boxes, verbal descriptions of an unknown sound in the environment, braille, audiobooks, or add tactile elements to a game or book.
Reduce visual clutter: Many with CVI have difficulty processing too much visual information at once. Some examples of how you can reduce visual clutter include:
- Present items on a slant board or against a blank wall.
- Adapt worksheets to reduce extraneous visuals.
- Take a picture of the worksheet on a tablet and zoom in to how one item at a time.
- Fold a worksheet to help students focus on one question at a time.
Incorporate opportunities for visual breaks: Constant visual stimulation throughout the school day can lead to visual and overall fatigue. Activities that require intense use of other sensory systems, such as physical therapy or gym, can make it even more challenging for some students to access learning activities. In addition to proactive breaks throughout the day, create opportunities where students can use other sensory channels and compensatory skills to learn, giving them a break from visual input.

Environmental adaptations

Reduce visual clutter: The classroom/environment you and your student work in may be filled with lots of materials that can be visually overwhelming. You can reduce visual clutter by using barriers to block classroom clutter, place a black sheet over busy book shelfs, clear a small portion of a wall for the student to face when doing demanding learning tasks
Consider lighting/noise sources: Individuals with CVI may be impacted by other sensory distractions, such as lighting and sound. It is important to consider how your student’s learning is impacted by lighting and sound and create accommodations to support their learning. For instance, if bright light is distracting, you may consider covering the overhead light with a light filter or using a dimmable lamp. For sound, if an environment is too noisy, you may consider providing the student with noise canceling headphones or finding an alternate location that is quieter.
Maintain routine and organizational systems: Students with CVI often benefit from predictable routines. In addition, since their functional vision may fluctuate, they frequently benefit from structured organizational systems of the environment and classroom materials, so they can use a combination of vision, compensatory skills, and motor memory to locate items and navigate the classroom and school environment.

Find more ideas for easy classroom adaptations that can help kids with CVI.

Collaboration ideas

Observe the TVI: It can be beneficial to observe your student working with their Teacher of Students with Visual Impairments (TVI) to see how the TVI implements interventions and accommodations.
Seek input from your student: Individuals with CVI are experts in their own vision and the supports help them learn best. When possible, ask your student if an intervention or accommodation you tried was helpful, what makes learning materials accessible for them, and consistently offer the opportunity for your student to choose if they need a break.
Discuss your observations with the classroom and special education teachers: You often spend more one-on-one time with the student than anyone else on the student’s school team. It’s important to discuss what you’ve observed working with your students (successes, challenges, changes in behavior) in order to ensure that the classroom teacher and special education teacher can work with the team to adjust instruction and IEP programming as needed.

Inass reaches out to touch a tangible symbol held by her teacher, engaging in a tactile learning experience tailored to her needs.

Resources on CVI

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.

Nicole Homerin, M.Ed

Nicole Homerin, M.Ed. (she/her) is the Director of CVI Education in The CVI Center at Perkins School for the Blind. Nicole formerly served as a special education teacher for students with a variety of disabilities, including CVI, in both Boston and Los Angeles. Nicole is passionate about disability advocacy and making learning accessible and equitable for students and teachers alike. She was named the 2023 Steve Bartlett Award recipient by RespectAbility for her work in disability advocacy, leadership, and empowerment. She was also named the recipient of the 2023 Trailblazer Award from Boston University Wheelock School of Education and Human Development for her exemplary leadership in the fields of education and disability advocacy. Nicole holds a Master’s Degree in Special Education from Boston College and a Bachelor’s Degree in Early Childhood Education from Boston University.