CVI Teachable Moments


Hello, and welcome to Perkins eLearning To Go. Each week, our hope is to provide you with an inside look at special education topics, in particular visual impairment. Through a series of interviews with leaders in the field and a fresh look at our webcast series, we know you will learn something new when you are on the go. Now, it's time to sit back, relax, and let's hear what this week's podcast is all about.

Welcome to Perkins eLearning To Go. This is Valerie. We have a couple teachable moments for you in this week's podcast. Ellen Mazel will be discussing two different subjects for teaching children the CVI, symbol understanding and color highlighting. The first half will cover symbol understanding.

Developing this skill begins to build during phase 2, when a child is able to recognize an item in 3D form, but is then taught to recognize the same item in a 2D symbol. Ellen will talk about how to help the child in phase 2 progress from a 3D object to the photo. The second half is color highlighting.

Color highlighting really helps children with visual motor functions, and for increased independence. Children in phase 2 have a favorite color. And it's very important for us to assess exactly what their favorite color is, as color highlighting can help determine where an object is in space. I hope you enjoy these teachable moments.

A title, Symbol Understanding for Children with CVI, with Ellen Cadigan Mazel.

Hi, my name's Ellen Cadigan Mazel. And welcome to this teachable moment, symbol understanding for children with cortical visual impairment. We're here today to discuss symbol understanding that begins to build in phase two of cortical visual impairment.

And, of course, we measure cortical visual impairment on Christine Roman's CVI range. When we talk about the CVI range, we want to see children begin to not only look, but to look and recognize. And, again, this is the skill that begins to build in phase two of CVI.

So the goal is, in phase 2, vision plus function-- vision and understanding, and acting on the world. Students in phase two are beginning, again, to use that very central vision, that ventral stream vision, in order to look, and look for longer periods of time. They're looking around in their environment to the things that they're familiar with.

Teams will see this building vision, and immediately want to jump to pictures, line drawings, and icons for communication symbols for their children. They want them to place those symbols in large arrays on communication boards. And a teacher of the visually impaired must be involved in that, so that that system is accessible for this child.

These flat 2D symbols represent the 3D materials in the environment. But here lies the problem. Children with cortical visual impairment have a limited number of things in the world that they can look at. So by jumping to flat 2D, that child might not even have a solid idea of what that real three dimensional item is in their environment.

So we can't just jump to that flat two dimensions without very, very careful thought, and very, very planned instruction. These children have fewer solid visual memories. Using the CVI range will really help us to decide what's accessible for a child, what flat materials are accessible for a child, and what array that flat material can be presented in, in order for the child to use that symbol system correctly.

Speech and language therapists have a progression of symbol systems. But I would say that does not factor in for kids with CVI because of the visual skills. I propose that there's a visual progression for children with CVI for understanding symbols. So here's the symbol progression that I think is involved with children with CVI.

They begin by understanding real items in their environment, favorite things in their environment, like this bottle of bubbles. If I see a child make a choice to have these bubbles, or I see them smile in recognition when they see this bubbles, I know that this child has a firm visual memory of this particular item in their environment.

Once I'm sure of that, I want to present this item with many other items and see if they, in a larger array, can find this three dimensional item in a larger array of other items. That would be my test before moving to the next step. So the next step, I propose, is embedded symbols, or mounted symbols.

And these symbols are mounted on either a 5 by 7 or a 4 by 6 card that begins to look like a photograph. It begins to look like the beginnings of a symbol system. But it still has these three dimensional elements that the child can hang their hat on. And that's very important for kids with cortical visual impairment, because it's a great leap from three dimensions to two dimensions.

As the children get more skilled at recognizing the embedded symbol, or the symbol that's mounted on the card, we want to take a picture of that exact same embedded symbol to go to our flat picture, our flat photograph. So objects might be used as choice items, for instance. So if the child likes this favorite fan, again, we want to make sure that the child is recognizing this, that they choose it often, that they smile and recognition for it, or that they pull us towards it in an effort to get in their environment.

We want them to have solid understanding. But we want to make sure, again, that when I place it in a large array of items, they can still locate this favorite item, because in phase two of cortical visual impairment, the number of things you look at can be very difficult. Each child will have a unique set of tolerance for an array. We have to check that at every step.

Once I know that this child can find this fan in a large array, I know they might be ready for the next step. That next step, embed, or a place, attach, the symbol onto a card, a 5 by 7, or a 4 by 6 card. I choose those sizes because that most likely mirrors the real size of the real item. So that's why I'm picking that size.

And, again as the child moves to this higher level of symbol systems, we really want to check that with an array. Put many, many items in on the symbol system, and check and make sure that they can still find this item in that larger array before I move to the next step. And, again, that next step is to take a photograph that very much mirrors the size of the embedded object. So this leap from three dimensions to two dimensions is carefully planned, and not that big of a visual leap for children. Imagine showing a child this in a much smaller picture that's an inch square, two inch squares. That's too much of a lead for a child with cortical visual impairment to recognize.

Maybe some symbol systems are being used for activities in your environment, or class activities in your environment. So maybe this pink ball gets an understanding that this is going to be the sign for gym. Going to gym is always represented by a pink ball. So we want children to have this three dimensional system in their calendar system, until they can recognize it.

And, often, for gym, I might get a smile. If the child doesn't like gym, maybe they cry. But I know, I have some ideas that they really are recognizing this.

And when they get to the area, when they get to the gym, they'll match that to a similar system on a card to let them know where they are in space. And I think this is a very good idea for orienting a child in their environment. Again, with solid understanding of my three dimensional ball, I can move to that attached or embedded ball.

And, again, presenting it by itself, still getting recognition, increasing the array, and still getting recognition before I ever think about moving to the next step, which, again, is a 5 by 7, or a 4 by 6 card that very much mirrors size of the original embedded object that they're having success with. When I think about choosing symbols for children, I want to make sure that they're vastly different in color and shape.

So I really don't want two items that a child is using for communication to be alike in color or alike in shape. So if I'm picking a jacket symbol and a backpack symbol that are both blue, those are too similar. They're square-ish.

They're too similar. And they're the same color. I find with children with cortical visual impairment, they're often coding by color. So we want items vastly different and shape, vastly different from color, so that this discrimination is easier for a child.

TDIs, in collaboration with speech therapists, really have to always be checking that the children visually understand. So often, I find that children are using symbol systems that they're not even looking at. So we have to be very, very careful that the children understand individual items on their symbol systems, and that does not decrease when the array, the number of items on the communication system, increases. That's a constant check that we need to do.

So we know that communication is really, really necessary for a child to express their wants, their thoughts, their ideas. We really want to make sure that we're providing the appropriate visual access so that the children are really, really understanding what's on their board, what their choices are, what their thoughts are, so they can effectively build their language skills.

Color Highlighting for Children with CVI, with Ellen Cadigan Mazel.

Hi, my name's Ellen Cadigan Mazel. And I want to welcome you into this teachable moment. Today, we're going to be talking about color highlighting for children with cortical visual impairment. Color highlighting becomes especially important as children enter phase 2 of CVI.

And phase two is as measured on Christine Roman's CVI range. The goal in phase two is to function in the world, to reach, to access materials, to gain information, to build independence. Now that the child is exploring themselves in the environment, they are combining their sense of vision with hearing, touch, smell, taste, and getting a full, multi-sensory idea of what's in their environment.

Students in phase two are beginning to use that more central stream vision, that detail vision that they need in order to function best in the world. They're sustaining gaze longer, and able to learn longer sequences. Using color highlighting really will help children use this ventral stream detail vision most effectively.

So color highlighting helps with several things. First of all, it helps, where is this object in space? Children with CVI will struggle with relative distance. So where is this object in space? Or what's the best place to grab this item or reach for this item?

And how do I have something in my hand and put it into a smaller container, or a smaller slot-- again, that idea of relative space with vision. Because children in phase 2 have a favorite color, it's very important for us to exactly what their favorite color is. For most of the things here today, I've used red as the color highlighting.

But that's not always necessary. You have to really decide what the child's favorite color is. And I don't mean favorite color for their clothes. I mean what color draws their visual attention to the most effective degree? And that's the color we want to use for different children's highlighting.

So if we think about position in space, a child might have the activity where they need to put this on a blackboard in the classroom. The teacher wants them to take the symbol and put it on the blackboard in the classroom. As the child gets close to the blackboard, they begin to drop this. They don't understand, where is it that you want me to put this in space?

So by simply creating some color highlighting on that board, the child understands, oh, that's where you want me to put it. And there it goes right on that board. Now, once a child can do a task, we want to think about really removing the supports.

So perhaps in the beginning I take away one piece of the support, then the sides, and eventually the bottom. So they need no support for that particular task that. The idea is always to put the supports in place and then assess when you can pull those supports away.

When we think about what's the best place to grab, we want to highlight that for children. So on a lunch box, the best place to grab would be the top to keep the orientation. If you want the child to grab their notebook, perhaps highlighting both sides of the notebook. So these are the places their two hands will go to then carry it to their locker or carry it to the teacher's desk.

If you want them to pull down their own zipper perhaps some color highlighting on the zipper will help them locate the zipper pull and be able to independently remove their coat. If I have the APH spinner, the important part that I want the child to reach to is the tabs that will actually make the spin. That would be the salient feature I want the children to pay attention to.

As the children start to be dependent with their ADL skills, I want them to know the best place to grab their brush. So I don't want to highlight the top of the brush. I want to highlight the handle. And, again, we're thinking about reducing this support as the child gets this skill more and more solidly.

If I want children to turn on toys independently, I would highlight the switch that can operate the toy. And, again, as the child gets familiar with this particular toy, I can reduce this highlighting. I'm not leaving it in place forever.

What we think about children taking something and putting it into holes or into containers, we can use an all done bin. And when we first began using the all the all done bin, the children would not accurately put it inside the all done bin. But color highlighting the edge really help them understand, where do you want me to put this? Where's the best place to put this?

So color highlighting the edge becomes very important. With the occupational therapist, she was using this pig, this musical toy pig. What's the most important part of this pig when you want to operate it? It's the slot. So once you've highlighted the slot, the child knows exactly where this material is supposed to go.

Red sorting trays-- a child that you want to sort certain items by category, say circles here squares here, they have to know where each item is supposed to go. So just by color highlighting, this becomes very, very clear for the child where those materials go. And then they can show you their true cognitive skills. As children get older, and they're doing an assembly task, color highlighting the different parts of the assembly task really keys them into where in space the items go, where in space the items can be obtained.

Highlighting in the environment is also important. We might need to highlight door handles for children to get in and out of the room effectively. We might think about highlighting a chair so the child can move into a seat on their own. We might want to highlight the sides of walls going from one room to another so the child has a distinct area that they understand that the space is going from one area to another.

Any drop-offs get highlighted with some of red highlighting, or whatever the child's favorite color is. Drop-offs, steps up, all will really help the child move independently through the space. For most of the materials that I highlighted here, I used red duct tape. This comes in many colors.

So you can find this match to your child's assessed color preference. But you can also use what's called gym tape or painter's tape. The benefit of that is it removes easily. I know many of the schools that I work in don't want me putting duct tape all over their room.

So it's easy to remove. So that's an option too. So color highlighting really, really helps children with those visual motor functions, and for increased independence.

So we want to use it very thoughtfully, and in a very targeted way. Here's an example here. For color highlighting, I know the child's favorite color is green.

The task is that the occupational therapist wants the child to pull on the tabs to untie this. So I'm not color highlighting the book. I'm not color highlighting the ties, the entire tie. I'm highlighting where I want them to reach. So, again, thinking very thoughtfully about where do I highlight? What do I want the child to have their vision and their motor skills drawn to is very, very important.

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