The Bridge School

Cortical Visual Impairment

Case Study: Abigail

Before systematic CVI interventions: In Preschool and Kindergarten (2009-2012) Abigail was very socially engaged with peers and adults, but showed little interest in classroom materials and limited understanding of common objects.

 

2013 CVI Range Score = 4.75 (age 7, grade 1).

Recommendations

  • Present 3-D objects when possible.
  • Reduce complexity of 2-D objects, present with backlighting or highlighting.
  • Present 1-2 items at a time on a solid black background.
  • Reduce interfering sensory input (background noise).
  • Modify visual targets with saturated color.
  • Allow extra viewing time, describe visual salient features of targets.
  • Increase expectations for looking at objects, classroom locations and partners. Gain Abigail’s visual attention before interacting.

Interventions

Examples of modifications and accommodations designed for Abigail.

Reduced environmental complexity by adding black background to lap tray.

Example of a book illustration in its original format.

Reduced complexity of the book illustration and presented on a lightbox.

Reduced background and desktop complexity at work station, simplified word wall words with Glow Writing.

Literacy instruction: taught the visual salient features of letters using a light box, Glow Writing and a laser pointer in reduced light setting.

Literacy instruction: taught the visual salient features of letters within whole words to support decoding skills.

Highlight sailent features: Used a laser point to highlight salient features of 2-dimensional materials presented on a lightbox.

Outcomes

Educational Gains: Abigail’s ability to visually engage with educational materials increases her active participation in classroom.

Educational Gains: Abigail’s ability to visually engage with educational materials increases her active participation in classroom.

The CVI Range is completed each spring. Abigail’s initial CVI Range score in 2013 was 4.75. In 2016 she scored 7.0 on the CVI Range. Abigail’s mother reported that at a recent check-up her ophthalmologist noted improved visual function.

Educational Gains: Abigail accesses a more complicated visual display on her desktop computer for typing. She independently copies words from her sight word wall.

Educational Gains: Abigail’s sight word vocabulary is growing, as well as her visual decoding skills. She no longer requires backlighting for viewing familiar literacy targets.

Self-Determination: Abigail is building stable visual representations of important objects in her environment and learning how to impact her environment by physically accessing/operating those objects.

Self-Determination: Abigail is building stable visual representations of important objects in her environment and learning how to impact her environment by physically accessing/operating those objects.

Communication and Social Engagement: Previously, Abigail’s communication device was mounted behind her, out of sight. She accessed it with a switch and only auditory prompting.

Communication and Social Engagement: Today, she is trialing a large-screen device and prefers to have it mounted in her best visual field.

Communication and Social Engagement: Abigail visually follows the magnification as picture symbols are highlighted (and she hears an auditory cue) and uses a switch to select her words and messages.

Communication and Social Engagement: Abigail is more socially engaged and demonstrates increased nonverbal communication skills by looking towards communication partners during interactions.

Communication and Social Engagement: Abigail is more socially engaged and demonstrates increased nonverbal communication skills by looking towards communication partners during interactions.

Questions, Challenges, Next Steps

  • Strategies for training team members outside of Bridge School: how can interventions and accommodations carry over to other settings (home, community, etc.).
  • The need for changing and adapting interventions over time as vision improves and to continue applying strategies that challenge students to use their vision more and more.
  • Giving students the knowledge, training and tools to understand their own visual needs and self-advocate for appropriate accommodations.