Supporting children with cerebral visual impairment

Post date: 
Friday, 12 June 2015

In her second article in Insight’s series on CVI, Janet Harwood looks at practical strategies to support children who have cerebral visual impairment

 
Insight Issue 51 explored characteristics of CVI and the importance of appropriate assessment. We stressed that CVI affects how children process visual information in different ways, and to varying degrees.
 
Helping families to understand their child’s behaviours and where possible to develop a child’s visual potential, and providing advice to all involved about lessening the impact of CVI, can have a life changing impact on those affected by it.
 
Remember that the way the child “sees” is normal to them. They may have “perfect vision” but be unable to process what they see in the wrong environment – this can be difficult and frustrating for others to understand, particularly where a child can see something in one context but seemingly not in another. Some children with CVI may also have an eye condition causing visual impairment.
 

Avoiding sensory overload

A noisy busy environment can overload children with CVI, asking them to process more than they can cope with at once. This may affect behaviour negatively or they may appear to shut down and switch off. Not paying attention may be their way of saying, “Help I’ve had enough, I can’t cope with all this!”
 
Bold, high contrast, plain and clutter-free presentation is best. Things are more easily located on a plain high contrast background, as the brain doesn’t have to work so hard to process as much visual information.
 

Shared attention

When a child gets home after a long day trying to concentrate and process information at school, they are often tired. Parents and carers may notice processing difficulties which are less apparent at school, or which may be put down to lack of attention at school. Shared attention during listening and talking can be very difficult for a child with CVI to sustain. It is difficult to watch a face and listen to what is being said, so the child may look away. Saying “Look at me when I’m talking to you,” can make it worse!
 
A child with CVI has to work very hard to process information, so tires easily – small activities, little and often, work best. Less is more – fewer things to process means being able to do it more easily.
 

Social care and habilitation support

If a child with CVI is looked after in care, it is vital that everyone responsible for their care understands how CVI may affect them and are consistent in how they work with them. We delivered training to staff at a children’s care home.
 
Children with CVI may need support from a habilitation officer to learn to travel safely and independently. In Brighton two children with CVI, whose level of ocular visual impairment would not normally justify such input, have benefited from mobility sessions, and one finds that using a cane helps her considerably.
 

Curriculum access

To access the curriculum children with CVI may also need the type of support that is usually given to children with a visual impairment caused by an eye condition. For example they may benefit from using technology to record their work, adapted keyboards which make it easier to locate letters and numbers, touch typing with speech input, magnification and so on.
 
A child with CVI often needs a print size far larger than the size they can “see”, in order to read effectively. Line and even character spacing can make a big difference. For several children on our caseload these changes have made the difference between children learning to read effectively, where in a few cases they were not learning to read at all. Providing that the largest font size is big enough, eReaders such as a Nook GlowLight can make a big difference and children are generally keen to use this “mainstream” popular technology. Photocopied enlarged materials are not good, as they are grey on grey and often provide poor contrast.
 
In-service training is key. Even where staff have heard of CVI, few have much knowledge of how it may affect the individual they are working with. Never assume any knowledge where CVI is concerned!
 

Contrast and faces

Children with CVI may have poor contrast sensitivity, even when good vision is present. Good contrast sensitivity is necessary to see faces and facial expressions. Little in the real world is of ideal contrast, which can affect the child’s ability to respond appropriately, even when “good vision” is present. At a glance a sighted person can see who is in a room and read their mood. Announcing your presence simply, telling a child that you’re smiling, or that another child looks upset can help a child with CVI to read situations and feel more connected to the people they spend time with.
 
 
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