The following strategies may be of particular interest to those managing the effects of Cortical Visual Impairment (CVI), Dorsal and/or Ventral Steam disfunction and/or visual and cognitive impairment.

Cortical visual impairment refers to visual impairment caused by damage to the visual cortex and/or the posterior visual pathways i.e. a disorder caused by damage to parts of the brain that processes vision. Cognitive impairment here refers to someone who has problems remembering, concentrating, making decisions and solving problems.

I will follow this up with a more in-depth look at the Dorsal and Ventral stream then, ‘DEVELOPMENTAL HICCUPS AND PROFESSIONAL SUPPORT.’

Visual Conditions

• Avoid direct light sources to prevent unnecessary distractions

• Lighting should be spread out and not concentrated.

• If using natural light have the child’s back to the window.

• Visual clutter should be avoided on the work surface and in the background.

• The level of contrast between the test material and the background should be optimal.

• If possible brightly coloured material without unnecessary embellishment should be used.

• Your clothes can also be a factor and should be kept simple and of a single colour i.e.  visually simple not heavily patterned.

Stimulation Materials

• Items should be presented and well spaced.

• Verbal and/or tactile cues should be used where feasible.

• Visual field distractions should be taken into account and the material should be presented from the side of the better field.

A Few Guidelines

• Good/appropriate lighting is a major factor in utilising residual vision – glare should be avoided.

• Colour and/or tonal contrast are important.

• Ensure glasses, lampshades, windows, net curtains etc., are kept clean.

• Always allow plenty of extra time for someone who is multi-disabled visually impaired.  Everything takes longer.

• Consider how other disabilities might impact along with visual impairment.

• Visual impairment might cause panic, stress and/or irritability etc., through finding task fulfilment difficult.

• Do not see only dysfunctional sight.  Consider the whole emotional, intellectual, spiritual and physical person.

• Avoid sudden loud noises and/or touching etc., introduce yourself.

• Background sound may mask important information.

Processing Conditions

• Quite commonly the person takes longer to process information.  Therefore, slow down presentation and/or slow down speech.

• Perhaps lower your voice, this automatically slows down speech and usually the person automatically moves a little closer to hear better.   The method allows the individual to take the initiative in determining body space, which may be more comforting than when a stranger does it.

• More time is needed to generate a response.

• Allow more time before stimulus is modified or removed.

• Warm-up examples with demonstrations are often needed before starting an exercise to stimulate sight and the processing of visual information.

Multiple Impairment

• Careful observation during play and exploration may give indications about the type of activities needed for learning.

• Tap into, and build on, existing skills.  Learning will reach higher levels.

• If other senses are better developed than sight, use these to stimulate the processing of visual information.

Evaluation Tools

• Often people are uncomfortable during an assessment in an unfamiliar setting.  Spend time introducing the environment and those present before beginning an assessment.

• A familiar environment to observe the person’s coping strategies is needed e.g., the home or school.

• Observing differences in coping strategies between familiar and unfamiliar activities can offer further information about useful intervention strategies.

Motivation

People can be taught to use sight more effectively.  A very important aspect is motivation.  Some people visually impaired do not automatically use all of their vision.  Simply looking may require much effort, the act of looking therefore should be made rewarding.

Developing Visual Attention and Fixation

• To attract the person almost any bright object will do, for example use a torch, mirror and/or shiny object.  Ensure though that the person is being attracted by vision and not sound.
• If necessary, to gain visual attention, move the object backwards and forwards in front of the line of gaze.

• To build a visual attention begin close to and gradually increase the distance between the person and the object, until the optimum distance is reached.

• Similarly encourage peripheral vision.  Begin close to and gradually move the object of interest centre left, centre right, centre up and centre down.  (Note any functional difference in each eye).

Tracking

• Again, using a torch and/or shiny/brightly coloured object attract the person’s attention by holding it near the person’s eyes then slowly moving it away but keeping the person’s attention.  This way the person learns to retain fixation whilst an object is moved slowly up and down, left and right, right and left, diagonally and in circular motion.

• Repeat these over several sessions and then increase the distance until the person’s maximum visual field is reached.

• If the person reaches for the object, reward by allowing the person to hold and explore the object, this gives concrete meaning to a visual impression.

• Using rolling objects e.g., pull-along toys, clockwork toys etc., to encourage tracking.  A ball could also be used.  Roll it backwards and forwards in front of the person and also into their lap.

Hand-eye Co-ordination

• Wherever possible encourage the person to reach for an object.  Try to avoid putting something into the person’s hand, but instead, position the object so s/he can reach.  At meal times, for example, place food, containers, utensils, within reach and then encourage independent access.

• Hold an object in the person’s line of vision and encourage him/her to reach out and grasp it.  The object should be visually attractive and of a size capable of being held.

• Provide the person with plenty of visually interesting materials to reach for and touch.  Try making your own tactile books and then encourage the person to assist when turning a page.

• Gradually reduce the size of objects used to encourage the person to reach out and grasp.

More Suggestions

For today or in the future to encourage the development of hand-eye   co-ordination could be:

a.         Half cover an object with a cloth and encourage the person to reach out, seek
            and retrieve it.

b.         Encourage the person to remove pegs from a toy lorry and/or take rings
            off a stick.

c.         Begin by encouraging the person to place balls into a round hole.  Then, try placing objects into tins and then encourage the person to post objects into a ‘letterbox’.  The ‘letterbox’ could gradually be reduced in size and/or placed further away.

To Facilitate Communication Generally

Individuals with a cortical visual impairment may have hearing difficulties and or learning difficulties too.  To facilitate communication generally the following suggestions may be of use.

• Do not stand in front of a window as your face will be in shadow and/or surrounded by glare.

• Good lighting is essential.

• Do not try communicating whilst doing something else – you might turn your head away.

• Make sure you have the child’s attention before attempting to communicate.

• Give the child time to respond.

• Always consider the child’s field of vision.

• Speak within the child’s visual field (including signing).

• Always use speech – avoid gestures.

• Use a conventional voice.  Speech that is too loud will distort sound and lip patterns.  Speech that is too quiet will be difficult to discriminate.

• Use normal speech pattern, i.e., sentences made up of clear phrases, rather than single word utterances.

• A child picks up information from many clues in normal communication, e.g., tone of voice and/or touch etc.

*Black and White Interactive Visual Stimulation

(Although any visually stimulating objects could be used)

Here s/he can shake things hung from lengths of cord within a frame.  She uses energy productively whilst getting plenty of visual stimulation and tactile input.

A frame can be made from lengths of cane or dowel, held together by fruit frame junction connectors.  It can be equipped with various black and white objects, for example, furry dice, toys, balls, plastic chains, which can be mixed and changed when the child’s interest flags.

The Little Room – Idea by Lilli Nielson (Google to learn more)

The idea is to offer young people multi-disabled and/or visually impaired, and/or those experiencing slow development etc., an opportunity to develop reaching skills and the beginning of understanding space.  It is potentially of particularly use to encouraging visually impaired babies to reach out for objects. 

The Little Room’s size can be made suitable for each person. It can be something as simple as a cardboard box which can be increased in size as the learner grows or, a clothes basket. Objects are hung from the ceiling and walls, so that when the child moves, s/he experiences tactile/auditory contact and stimulation. (Note which sounds, textures, smells and/or shape s/he prefers). If you decide to make a Little Room under the stairs, under an enclosed table or box the learner should be able to see or sense the outside world. It should also be padded where necessary and thereby comfortable.

The learner is motivated to move her/himself around the space and then out of it.  The idea also offers the multi-disabled and/or visually impaired person an opportunity to play in a small space similar to that which able bodied people find under furniture when moving around and exploring.  At different times, move the Little Room, and hang different objects from it to stimulate curiosity.  Different tactile and sound experiences should always be within reach.