Procedure Cards adapted from The CVI Range p. 57-60, the CVI Resolution Chart p. 75-77 and the CVI Range Scoring Guide p. 97-109. Roman-Lantzy, C. (2007). Cortical visual impairment: An approach to assessment and intervention. New York, NY: AFB Press.
CVI Range 3-4 Student functions with more consistent visual response
- Procedure cards #10-18
- Photos of items appropriate to assess the characteristics
- APH product connections to increase more consistent visual response
- Strategies to consider for children in this range
Item 10. Visually fixates when the environment is controlled
Procedure
- Observe whether the student is able to establish eye-to-object contact when low levels of auditory, visual, or tactile competition are present.
- Offer the student a visually familiar or preferred object, then engage in low levels of conversation, add low volume music, or low volume, familiar environmental input.
- Offer the student an object that is visually simple (one to two colors) that also produces music, sound, or vibration.
- Offer the student an object that can be reliably viewed in an environment that is strictly controlled, but now add low levels of room light or environmental sound.
- Observe whether the student is able to maintain visual attention on the object or whether the introduction of the background light and/or sound results in the student failing to demonstrate visual attention toward the object.
Examples of Scores
| Resolved | Establishes eye-to-object contact with familiar or novel objects or human faces, even in the presence of visual or other sensory stimuli |
| + | Intermittent eye-to-object contact, but only when visual, auditory, and tactile distracters are reduced or eliminated; a small degree of additional sensory input may be tolerated while viewing |
| +/- | Occasional eye-to-object contact, but conditions for visual fixations may vary |
| – | May turn in the direction of a target, but no eye-to-object contact |
See Suggestions for assessment― complexity, environments
Item 11. Less attracted to lights; can be redirected
Procedures
- Observe whether the student can shift visual attention away from primary sources of light (ceiling lights, lamps, window light), or whether the student only ceases light gazing when the lights are turned off or eliminated.
- Ask the parent/educator/caregiver whether the student stares at lights.
- Adjust lighting environments so that the lights are lowered but not fully eliminated.
- Present objects to the student that have lighted components and those that do not.
- Does the student only look at the objects that have light?
- Does the student reportedly or by observation (direct evaluation) demonstrate visual attention primarily on objects that have backlighting (television, tablet devices, etc.)?
- May fail to close eyes when direct light from a color-filtered flashlight is passed in front of eyes.
Examples of Scores
| Resolved | Does not stare at primary sources of light |
| + | May stare at lights, but is able to shift attention from lights when appropriate visual targets are presented in controlled environments |
| +/- | Primary sources of light must be eliminated only on rare occasion for visual attention to occur |
| – | All primary sources of light must be eliminated for visual attention to a target to occur |
See Suggestions for assessment― light, complexity, environments
Item 12. Latency slightly decreases after periods of consistent viewing
Procedure
- Observe potential delays between the time a target is presented and the time when the student first visually attends (latency).
- Ask the parent/educator/caregiver whether the student appears to have periods of time when visual attention seems delayed or inconsistent.
- Proceed with activities that include preferred visual targets, and note whether the visual latency becomes shorter as the student gets visually “warmed up.”
- Evaluators may choose to time initial periods of latency (in seconds) and compare to duration of latency after the student has remained visually engaged.
Examples of Scores
| Resolved | A delay in directing visual attention toward a familiar object is rarely, if ever, present |
| + | Demonstrates a delay in directing visual attention to a target some of the time or for shorter durations of time; latency may fade as vision is used more consistently |
| +/- | Delay in directing visual attention toward a target occurs frequently, but not every time a target is presented |
| – | Delay in directing visual attention toward a target is always present |
Item 13. May look at novel objects if they share characteristics of familiar objects
Procedure
- Ask the parent/educator/caregiver to identify objects that are highly familiar to the student.
- Present these familiar or “favorite” objects to the student.
- Present new objects that are similar in color, level of visual complexity (one to three colors on surface), presence of light, presence of movement, and reflective properties.
- Observe the student’s visual attention. Does the student visually attend to the new, but similar, objects?
- Is there greater latency when the new, but similar, objects are presented?
- Does the student fail to visually attend to the new, but visually similar, objects?
Examples of Scores
| Resolved | Is able to glance toward or have eye-to-object contact with objects never previously seen that may or may not resemble “favorite” objects |
| + | Is able to glance toward or have eye-to-object contact with new objects if they have matching features of color, movement, or low complexity |
| +/- | Is able to glance toward or have eye-to-object contact with objects that have few similar traits, but may share at least one matching element or color, movement, or complexity |
| – | Is able to glance toward or have eye-to-object contact only with a small set of highly familiar objects |
See Suggestions for assessment― visual novelty
Item 14. Blinks in response to touch and/or threat, but responses may be latent and/or inconsistent
Procedure
- Without verbal prompt or forewarning, gently and quickly touch the student on the bridge of the nose between the eyes.
- Without verbal prompt or forewarning, quickly move an open hand toward the student’s face on midline and at eye level.
- Observe whether the student blinks simultaneously with the touch or the threat, blinks with latency, or fails to blink to either or both the blink to touch and the visual threat.
Examples of Scores
| Resolved | Blinks intermittently when touched at the bridge of the nose and/or when a target moves quickly toward the face |
| + | Blinks to the touch at the bridge of the nose and possibly to the quick movement of a target toward the face, but the responses may be delayed or slightly inconsistent |
| +/- | Blinks at touch, but not at a target moving quickly toward the face |
| – | Does not blink consistently at either the touch at the bridge of the nose or a target moving quickly toward the face |
Item 15. Has a “favorite” color
Procedure
- Ask the parent/educator/caregiver whether the student has a favorite color.
- Present objects (e.g., Slinkys® of various colors) or lighted targets (e.g., APH Variable Beam Flashlight light with colored lenses) that are identical except for color, and note any differences in visual attention.
- Observe student with preferred objects, and note whether the objects are a particular or consistent color.
Examples of Scores
| Resolved | Visual attention to objects is not dependent on a particular color |
| + | Continues to most consistently glance toward or have eye-to-object contact with targets made of a single color or preferred color, over objects of all other colors |
| +/- | Favorite color may be necessary to initiate looking; some part of the target may be made of the favorite color or preferred color for visual attention to occur |
| – | No consistent attention to objects |
See Suggestions for assessment― color
Item 16. Shows strong visual field preferences
Procedure
- Ask the parent/educator/caregiver whether the student notices visual targets in any particular position.
- Observe the student in a variety of settings, and note whether the student visually attends, reaches, or turns her head primarily toward a particular side or peripheral visual field.
- If the student is ambulatory, observe the student’s ability to anticipate surface changes, drop-offs, or obstacles.
- Perform a modified-confrontation visual field technique.
- Utilize a flashlight with colored lenses (e.g., APH Variable Beam Flashlight), and move light from behind the student into peripheral fields (right, left, superior, and inferior).
- Begin with preferred color, if one exists.
- Refrain from talking, or having student engaged in a visually preferred task, during this procedure.
- Procedure can be repeated with shiny or Mylar® target if light does not engage visual attention.
Examples of Scores
| Resolved | Visual attention occurs equally in all peripheral fields |
| + | Glances toward or has eye-to-object contact with targets when presented in specific positions of peripheral viewing fields |
| +/- | Glances toward or has eye-to-object contact with most targets, in most viewing positions, with a slight preference for the original preferred field/position |
| – | Glances toward or has eye-to-object contact in one viewing field only |
Item 17. May notice movement of objects at 2-3 feet
Procedure
- Ask the parent/educator/caregiver about the general distance and greatest distances at which the student visually detects or notices visual targets.
- Offer preferred objects to the student at varying distances up to 8 feet.
- Compare distances at which the student visually alerts to familiar targets.
- Note whether the student is able to even occasionally notice the movements of familiar people, or the movement that emanates from television shows, at distances that are greater than usual for the student.
Examples of Scores
| Resolved | Pays visual attention to objects that do not move or have reflective properties at distances beyond 3 feet |
| + | Glances toward or has eye-to-object contact with objects that move in space, or are made of shiny or reflective material, and are at distances up to 3 feet away |
| +/- | Movement or reflective properties are required to initiate visual attention; one element of the object may be moving, shiny, or reflective for visual attention to occur |
| – | Movement or reflective materials necessary for visual attention and viewing distance is within 18 inches |
See Suggestions for assessment― movement
Item 18. Look and reach completed as separate events
Procedure
- Offer objects to the student that are visually motivating and that have the appropriate visual aspects required for visual attention.
- Use of a black or plain background
- Object may have lighted or movement properties.
- Object may be a preferred color and visually noncomplex.
- Observe whether the student looks toward the object, then glances away, and then swats, reaches, or moves hand toward the object, while looking away from the object.
- If the student is unable to move his arms or hands, do not score this item.
Examples of Scores
| Resolved | Reach and touch occur simultaneously, even if inconsistently |
| + | Attempts to reach or swat at a target, but does not use a visually directed reach; look, look away, and reach pattern is used |
| +/- | Occasionally uses a visually guided reach |
| – | Makes no attempts to reach, but not due to motor limitations |