Anyone working with children with complex medical issues and/or DeafBlindness will have encountered children with the diagnosis of Cortical/Cerebral Visual Impairment (CVI). CVI is a brain based visual impairment which requires different approaches and strategies than other non-brain based visual impairments.
Chris Russell has provided us with a handy Fact Sheet on CVI that covers the major points of what CVI is:
What is CVI?
Cortical visual impairment (CVI) is a neurological form of visual impairment caused by “damage or atypical structures in the visual pathways and/or visual processing centers of the brain” (Roman Lantzy, 2018). CVI is the leading cause of visual impairment in children in countries or regions with access to quality neonatal health care.
How is it different from other visual impairments?
Individuals with CVI often have healthy eyes and obtain normal results on an eye exam, because it is the processing of vision in the brain that is atypical. CVI does not have an impact on visual acuity, contrast sensitivity, or many of the other symptoms of ocular visual impairments. CVI cannot be corrected with glasses.
Children and youth with CVI can be expected to make progress in their visual functioning over time if provided with appropriate assessment and intervention. CVI requires a very different approach to instructional supports and environmental/material adaptations as compared with ocular visual impairments.
How is CVI diagnosed?
There are 3 criteria for diagnosing cortical visual impairment:
o History of neurological impact, abnormal development, damage or trauma (the most common causes are anoxic brain injury associated with premature birth or other TBI [hypoxic ischemic encephalopathy, periventricular leukomalacia, stroke or seizure]). CVI can also be associated with genetic syndromes such as AGS, CDKL5, etc.)
o Abnormal visual behaviors that cannot be explained by the clinical eye exam
o The presence of unique visual Characteristics associated with CVI:
o Color preferences (often red, yellow, saturated)
o Atypical visual reflexes (blink to touch, blink to threat)
o Difficulty with visual novelty (easier with familiar objects, people, settings)
o Difficulty with visually guided reach (looking and reaching/touching at the same time)
o Difficulty with distance viewing
o Need for movement
o Visual latency
o Visual field preferences
o Need for/attraction to light
o Difficulty with visual complexity
It is so encouraging to know that CVI can improve when effective approaches and specific strategies are employed but this also places a burden on those who are on the child’s educational team to be sure that appropriate CVI assessments are done and that CVI approaches and strategies are employed and used daily with the child. Starting early is also very important to getting a good result for children with CVI.
Babies with CVI: Nurturing Visual Abilities and Development in Early Childhood by Anne McComiskey is a wonderful handbook on how to get started with babies and very young children with CVI and their families. I was lucky enough to attend a conference where Anne McComiskey presented on her book.
Some of the useful information in the book includes:
– How to help families who are working through the stages of grief.
– How to conduct an initial visit with parents of a baby with CVI.
– Parent friendly ways to teach the family about the visual system and how it works.
– Answers to questions parents frequently ask about CVI.
– Collecting information from the family, including a sample family questionnaire.
– How to create a Home Action Plan for the family.
– Intervention planning and preparation.
– Early visual development guide with explanation of how to assess each skill.
I wish I had access to a handbook like this when I was working as a TVI with the Early Intervention Program. Now I am happy to have it as I work to support teachers working with young children with CVI!
Babies with CVI by Anne McComiskey is available through APH Press.
Patty Dischinger, M.Ed.
Birth-Five Technical Assistance Consultant
ECU Teacher Support Program