The Bridge School and Environment

The Bridge School education program currently serves 14 students with complex communication needs and severe physical impairments often associated with cerebral palsy who require the use of Augmentative and Alternative Communication (AAC) systems. Our service delivery model is an interdisciplinary educational team that includes a special education teacher, speech language pathologist, occupational therapist, assistive technologist and several instructional assistants. For students diagnosed with CVI, a teacher of the visually impaired (TVI) typically serves as a consultant for the delivery of services and recommended interventions within our ongoing curriculum.

Research has shown myopia, cortical visual impairment (CVI), strabismus and gaze dysfunction co-occur in 70% of children who have severe physical impairments associated with cerebral palsy. Thirty percent of these children are diagnosed with CVI (Ghasia, Brunstrom, Gordon, & Tychsen, 2008) and it is the “fastest growing visual impairment diagnosis today” (American Printing House for the Blind, What is CVI?). At The Bridge School, approximately 50% of our students have received a diagnosis of cortical visual impairment.

In order to address the needs of our students, it was necessary for our staff to learn as much as possible about CVI, to determine how to integrate effective intervention strategies throughout the school day and to develop appropriate goals and objectives for inclusion in the students’ educational plan.

Pie chart with equal sized slices labeled clockwise from upper left: Sensory Modalities, Language, Environment, Personal Experiences, Cognition, Physical Abilities, IEP and AAC Goals, Health and Medications.
Each student at The Bridge School has unique needs to be addressed within the educational program including language, physical abilities, health and medications, environment and personal experiences. All of these elements have an influence on one another and make up our students’ profile as a whole. For those students diagnosed with CVI, addressing their vision needs becomes an important piece of the larger picture.

The Need for a CVI Assessment

While (CVI) identification begins as a medical issue, it becomes an educational issue….

American Foundation for the Blind (AFB) website, 2016.

At The Bridge School, interventions to address a student’s vision needs have always been based on the recommendations made by ophthalmologists, vision clinic assessments and Teachers of the Visually Impaired. Before 2012, most Bridge School students with CVI received the same general guidelines:

  • Enlarging educational materials
  • Utilizing high contrast, primary colors and bold outlines
  • Minimizing clutter and crowding
  • Having expectations that a student’s vision will be intermittent and will fluctuate throughout the day

Abigail can more effectively use her vision when items are presented with backlighting. By using a lightbox and obscuring extraneous material, the teacher is able to direct Abigail’s focus to the specific part of the picture they are addressing.

While these recommendations established the basic parameters for intervention, the individual and unique needs of a student with CVI and SSPI changed throughout the school year. The availability of a CVI assessment that could support development of accommodations and interventions as the school year progressed and that also kept pace with a student’s development, was important. Assessments that addressed language, communication, academics, assistive technology and augmented alternative communication were already available to The Bridge School team and they guided interventions as a student’s needs changed. The critical missing element was a process to assess why and how vision accommodations should be designed and when they should change. This was necessary to create and present learning scaffolds that were current and designed to meet the needs of each student.  Most importantly, teachers and SLPs needed the tools to assess how a student’s CVI impacts their education and how it contributes to overall language and communication development.

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