English Language Arts (ELA) - Cortical Visual Impairment The Bridge School

As our Curriculum in Action outlines, our teachers and SLPs carefully assess each student’s language and literacy skills and design individualized instruction that includes accommodations to address challenges of ELA instruction and learning by students with SSPI. We introduce accommodations such as AAC tools and devices, adaptations of printed materials, environmental arrangements and workstation set-ups for instruction in key areas of reading, phonics, writing and vocabulary comprehension. CVI interventions are used to support all areas of our ELA curriculum.

Increasing Participation

Adam’s goals for ELA are to increase his independence by taking more turns and making clear choices. The accommodations for this activity focus on making a set of objects more visibly accessible by using light paired with the color red, his preferred color. The objects being used represent symbols for song choices.

In the following set of pictures, Adam is being presented with items used to represent song choices that accompany his ELA unit.

Adam is being asked to look at a picture of a brush wrapped in red mylar presented on a black background. He may be listening to his teacher but he’s not visually attending to the items.

Adam is being asked to look at a picture of a red shoe presented on a black background. He may be listening to his teacher but he’s not visually attending to the items.

In the following pictures, the classroom lights have been dimmed and items are placed on a light box.

A laser pointer is being used to highlight the brush. Making accommodations for Adam’s CVI increases his visual engagement. His eyes lock on each item, and the teacher labels and sings a part of the lesson’s songs.

After repeating this lesson, over time Adam began reaching for the items presented. Associating language with visual representations strengthens Adam’s use of AAC while building his comprehension.

Teaching Visually Salient Features

For students attending to 2-demensional representations, teaching visually salient features is a CVI intervention taken directly from a Christine Roman-Lantzy CVI workshop. The intervention is used during direct instruction and its goal is to teach students with CVI the salient features, or special characteristics that make an item visually distinct. The goal in teaching salient features is that students will build the metacognitive processes for looking and problem solving the visual world when they can use visually descriptive language to support and identify what they see.

(The students using these materials and receiving this instruction still needed accommodations like backlighting, less complex images to look at, and some of them worked best in a quiet, low-lit room. But, their level of CVI was such that they could begin to fixate on a specific target and then learn how to study the visual details of that target.)

Teaching Visually Salient Features to Support Recognition of Novel Visual Schemas

The following are 2 example lessons teaching salient features.

Example Lesson 1: Learning about Cats

1. Realistic pictures or illustrations depicting main concepts and themes are adapted to remove background, so that only 2-3 distinct visual features remain. The exact language used to describe the salient features is written in the corner of each image. This supports student comprehension and recognition of the image when it is presented in different lessons, or when presented by different teachers. Using consistent language to label a referent when learning something new, supports student comprehension and recognition.

2. The images are presented with back lit lighting like a light box or on a PowerPoint document presented on a computer.

3. The language used during instruction teaches students the salient features they should focus on within the image.

4. Once students are familiar with the images and the language used to describe the image, several similar images with the same salient features are presented in the same manner as the original.

5. After students are familiar with these additional images, they are now presented with images with different salient features. This is called teaching comparative thought. Comparative thought activities help students build an internal understanding of what things look like and then apply that understanding when new things are encountered. As students become more familiar with this visually descriptive language and with the habits or processes of looking and studying things in their environment, we are hoping to build or entice their visual curiosity to help them build cognitive processes for looking at and problem solving the visual world.

Teaching language for comparative thought:

Cat

2 pointy triangle ears
Long skinny tail
2 eyes close together

Rabbit

long ears
Small round tail
Eyes on the side of it’s head

Example Lesson 2: Learning about Faces

2. The images are presented with back lit lighting like a light box or on a PowerPoint document presented on a computer.

Teacher showing an image of a face in front of a light box to a student in a wheelchair

3. The language used during instruction teaches students the salient features they should focus on within the image. This is an example of one student’s AAC device with some of the descriptive vocabulary used during this unit.

Digital screen displaying several tiles with images and words showing several different options for common physical characteristics such as eye color and hair color and length

4. Once students are familiar with the images and the language used to describe the image, several similar images with the same salient features are presented in the same manner as the original.

Abigail could not identify a picture of her mother. Her teacher talked about the salient features of her mother’s face and mouth.

Next, her teacher introduced similar images of mouths and how they shared the same features as her mother’s mouth.

At the end of several days, Abigail was able to look at and match her mother’s mouth to her face.

5. After students are familiar with these additional images, they are now presented with images with different salient features. This is called teaching comparative thought. Comparative thought activities help students build an internal understanding of what things look like and then apply that understanding when new things are encountered. As students become more familiar with this visually descriptive language and with the habits or processes of looking and studying things in their environment, we are hoping to build or entice their visual curiosity to help them build cognitive processes for looking at and problem solving the visual world.

Teaching language for comparative thought:

Top photo

Dark long hair
Can’t see ears
Brown eyes
Round face

Bottom photo

Short lighter hair
Can see ears
Blue eyes
Thin face

Outcomes For Teaching Visually Salient Features

Students with CVI will increase their visually curiosity.
They will look at and identify novel items in an environment.
Distance viewing will be enhanced.
Discrimination, recognition and identification of 2-dimensional material will be enhanced.
Experience using descriptive language that identifies and compares items viewed visually will increase.

Working with Letters and Words

Bridge School students with CVI who are able to recognize very familiar 2-dimensional pictorial representations but typically rely on information begin spoken before relying on their vision, are taught the salient features of whole words and letters to access written text. The CVI intervention to teach salient features of letters is the same used by Christine Roman-Lantzy to teach high frequency sight words.

Interventions for these students include:

Presenting material on a backlit surface so students with CVI will look at something quicker, longer and with greater attention.
Using phosphorescent color to help draw attention to shapes of letters and words while highlighting their most important or salient features.
Reducing complexity of visual information by teaching letters and words as isolated units.

The letter tiles are typical examples of letter representations easily mapped by students who can see letter shapes.

This is an example of highlighting letters, an intervention taken from Christine Roman-Lantzy that Bridge School has adapted and calls Glow Writing. Glow Writing is an outlining feature available in the newest versions of Microsoft Word and PowerPoint. Glow Writing mimics neon signs and works to catch visual attention.

We start letter instruction by teaching salient features while the student makes the letter shape. The following are two example lessons on Learning about Letters.

Example Lesson 1: Learning about Letters

Abigail is studying the salient features of a letter shape on a light box.

Abigail is given a choice of 2 letters to match the outline.

Abigail picks one letter and the light from the light box helps her see the letter doesn’t fit the cut out. The visual support is helping her understand visual detail.

Here, Abigail has successfully found the matching letter for its cutout!

Example Lesson 2: Learning about Letters

Jackie is learning the salient features of letter g. She reviews the letter she’s to build by watching it traced on an iPad.

The backlighting of both the iPad and light box draw her eyes to the letter’s features. Using glow shapes, she attempts to build the letter g. She picks the straight line and small curve at the bottom of the g. We say the small curve at the bottom looks like a little smile to help her build a comparison of something else that has that shape.

Jackie picks a half circle to complete the g, and then identifies her mistake because it doesn’t match the letter g presented on the iPad.

Finally, Jackie picks the other half circle and she’s successfully completed the letter g.

Outcomes for AAC

For Bridge School students with CVI who use AAC, positive intervention outcomes of teaching salient features of letters indicate students are:

Building better memory and more knowledge about where their letters are mapped on their communication devices
More focused on the task and work for longer periods of time
Building visual memory to support recall when it’s time to spell

The following photos illustrate examples of two students with two different CVI profiles and how those profiles impact the design of their AAC alphabet boards.

Jackie can monitor all the letters within a single display.

Abigail needs less complexity in visual displays. She has full access to all 26 letters but they are displayed 4 at a time.

Sight Words

The CVI intervention to support students with CVI learning sight words follows similar steps used for learning individual letters.

In this example, the objective is to have students match a sight word to its cut out shape.

Students practice identifying adapted words from the CVI adapted sight word wall.

Connected Text

The next step in teaching students with CVI to identify text is to have them read connected text after identifying sight words in isolation. Having students with CVI access text in its most visually conventional form is the long-term goal for intervention, and students must be monitored and interventions adapted as their CVI profiles change.

The text is still adapted with Glow Writing and complexity of the overall display is reduced.

Further support to read connected text is given by isolating words within the sentence using a black sheet of paper with a cut out hole.

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