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Orientation and lenght of lines. CVI. Refraction and motor functions. Picture perception&recognition. General Features. &. SYMPTOMS. Motion perception and VField. OUR GOAL. to understand each child’s visual functioning. Children with CVI. OUR GOAL: to understand

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slide1

Orientation and lenght of lines

CVI

Refraction and motor functions

Picture perception&recognition

General Features

&

SYMPTOMS

Motion perception and VField

our goal
OUR GOAL

to understand each child’s

visual functioning

children with cvi
Children with CVI

OUR GOAL: to understand

  • the quality of the image
  • the use of information in higher visual functions
  • the role of vision in development

and education

visual impairment
Visual Impairment

affects four main areas:

  • Communication
  • Orientation & movement
  • ADL, daily living skills
  • Sustained near vision tasks
visual impairment8
Visual Impairment

Basic questions:

How does vision affect this function?

How is vision going to affect development of this function?

Does the child have compensatory techniques? How do I teach them?

visual impairment9
Visual Impairment

Basic questions:

How does vision affect this function?

How is vision loss going to affect development of this function?

Does the child have compensatory techniques? How do I teach them?

How do I help the child to develop compensatory techniques?

slide10

Orientation and lenght of lines

Refraction and motor functions

Picture perception&recognition

CVI

Motion perception and VField

visual cortices
Visual cortices

posterior parietal

eye-hand coordination

spatial awareness

frontal

recognition

inferotemporal

slide14
CVI

Often a part of larger brain damage >>

thus

Cerebral visual impairment

or

Brain damage related

visual impairment

brain damage related vi
Brain damage related VI

Caused by:

- lesions in visual pathways

- cortical lesions, visual and other

- subcortical lesions

- leads touneven profileof visual functions, some good, some poor

important in assessment of children with intellectual disabilities

cvi behaviours
CVI - Behaviours

- VARIATION in visual behaviour

- effect of basic disorder

- effect of medication, wakefulness

- misunderstanding the functions

easy to us, difficult to the child

cvi behaviours17
CVI - Behaviours

- VARIATION in visual behaviour

- speech as compensatory function

cvi behaviours18
CVI - Behaviours

- VARIATION in visual behaviour

- speech as compensatory function

- plays with adults, not with children

cvi behaviours19
CVI - Behaviours

- VARIATION in visual behaviour

- speech as compensatory function

- plays with adults, not with children

- clings to parents in crowded places

cvi behaviours20
CVI - Behaviours

- VARIATION in visual behaviour

- speech as compensatory function

- plays with adults, not with children

- clings to parents in crowded places

- uses colours for recognition

cvi behaviours21
CVI - Behaviours

- VARIATION in visual behaviour

- speech as compensatory function

- plays with adults, not with children

- clings to parents in crowded places

- uses colours for recognition

- may learn letters early, only short words

cvi behaviours22
CVI - Behaviours

- VARIATION in visual behaviour

- speech as compensatory function

- plays with adults, not with children

- clings to parents in crowded places

- uses colours for recognition

- may learn letters early, only short words

- starts drawing late or never

cvi behaviours 2
CVI – Behaviours 2

- stops at thresholds and shadows

- depth perception

- perception of surface qualities

cvi behaviours 224
CVI – Behaviours 2

- stops at thresholds and shadows

- does not look at, ”avoids eye-contact”

cvi behaviours 225
CVI – Behaviours 2

- stops at thresholds and shadows

- does not look at, ”avoids eye-contact”

- peripheral vision better, central scotoma

cvi behaviours 226
CVI – Behaviours 2

- stops at thresholds and shadows

- does not look at, ”avoids eye-contact”

- peripheral vision better, central scotoma

- gets lost in familiar places

cvi behaviours 227
CVI – Behaviours 2

- stops at thresholds and shadows

- does not look at, ”avoids eye-contact”

- peripheral vision better, central scotoma

- gets lost in familiar places

- gets angry if objects are moved

cvi behaviours 228
CVI – Behaviours 2

- stops at thresholds and shadows

- does not look at, ”avoids eye-contact”

- peripheral vision better, central scotoma

- gets lost in familiar places

- gets angry if objects are moved

- uses siblings and adults for help

slide29
CVI

A list

of

typical behaviours

does NOT

help us to understand a child.

slide30
When a child has an unusual behaviour,

describing it is not enough.

slide31
When a child has an unusual behaviour,

describing it is not enough.

Try to find out WHY the child has that behaviour.

Consider other impairments.

Consider the situation.

angle cross
Angle & cross

Pen and spasticity

cognitive visual functions
Cognitive visual functions

Discrimination of orientation of lines

Discrimination of size/length of lines

Detection & discrimination of movement

Perception of texture, surface qualities

Object / background, Depth

Recognition of faces, expressions

Recognition of geometric forms

Perception of pictures

Spatial awareness, eye-hand coordination

slide38
CVI

Diagnose and therapy:

- team, transdisciplinary

- tests are used by everyone

- observation

- structured play situations

- repeated assessment

transdisciplinary diagnose
Transdisciplinary Diagnose

In the assessment of children with

brain damage related vision loss:

- ophtalmologist: anatomy, refraction

- teacher, therapist: observations, testing

- neurologist: dg, neurologic impairements

- neuropsychologist: cognitive vision

video documentation

assessment of functional vision
Assessment of functional vision

- basic information from the eye hospital

structure of the pathways, refraction,

glasses (under- or overcorrection?)

VA, VF, CS, CV, VAd, motor functions

assessment of functional vision41
Assessment of functional vision

- basic information from the eye hospital

structure of the pathways, refraction,

glasses (under- or overcorrection?)

VA, VF, CS, CV, VAd, motor functions

- testing of all visual functions in

play and teaching situations, effect

of other impairments and disorders

assessment of functional vision44
Assessment of functional vision

- basic information from the eye hospital

structure of the pathways, refraction,

glasses (under- or overcorrection?)

VA, VF, CS, CV, motor functions

- testing of all visual functions in play and

teaching situations, other impairments

- effect of posture and facilitation in

children with severe motor problems

four children
Four children
  • Prematurely born girl with problems in recognition of faces + other impairments
  • Boy with severe CP, poor head control and poor oculomotor functions, good VA, CS,VF
  • Girl with extreme hypotonia, insufficient accommodation, slow hand movements
  • Boy with deletion syndrome, central scotoma, hearing problems, delayed development
recognition of faces
Recognition of faces

Re-cognition:

- the facial features are seen

- a template is formed in memory

- the face is seen again

- template is found and matched

photophobia due to optic atrophy
Photophobiadue to optic atrophy

Glasses are tested both outside and inside

findings
Findings
  • A rare deletion in chromosome 2
  • MRI not yet possible, anesthesia dangerous
  • Optic discs greyish; hearing =? CAI?
  • Good orientation in space, explores
  • Reaches for and grasps
  • Notices grey on grey
  • Strabismus LE, does not seem to alternate
  • Seems to fixate at hair line > central scotoma
  • RE –3.0, LE –5.0 - -6.0 without cycloplegia
  • Vision for communication in lecture V.
four children63
Four children
  • Prematurely born girl with problems in recognition of faces + other impairments
  • Boy with severe CP, poor head control and poor oculomotor functions, good VA, CS,VF
  • Girl with extreme hypotonia, insufficient accommodation, slow hand movements
  • Boy with deletion syndrome, central scotoma, hearing problems, delayed development
severe multihandicap
Severe multihandicap
  • Highly individual
  • Difficult to assess, formal tests may not function

- detection tests do not measure form perception

  • Pleasure of seeing may be lacking

- no drive to look, learning through vision does not occur

  • Directing attention; comprehension; memory
  • No prior confirmation with mouth and hands
  • The child may be blind; hearing/ tactile/ haptic

- Try with very high contrast visuo-tactile toys, not too long.

levels of cvi
”Levels” of CVI
  • There are no general ”levels” of CVI
  • Each cognitive visual function needs to be assessed individually
levels of cvi66
”Levels” of CVI
  • Each cognitive visual function needs to be assessed individually
  • We do not assess all functions during the first examination, repeated assessments needed
levels of cvi67
”Levels” of CVI
  • Each cognitive visual function needs to be assessed individually
  • We do not assess all functions during the first examination, repeated assessments needed
  • Accept variation in results in CVI, try to find out the causes of variation
levels of cvi68
”Levels” of CVI
  • Each cognitive visual function needs to be assessed individually
  • We do not assess all functions during the first examination, repeated assessments needed
  • Accept variation in results in CVI, try to find out the causes of variation
  • Train to improve weak functions, find compensatory strategies, build on strong functions.
levels of cvi69
”Levels” of CVI
  • Each cognitive visual function needs to be assessed individually
  • Do not believe that you have assessed all functions during the first examination
  • Accept variation in results as a norm in CVI, try to find the causes of variation
  • Train to improve weak functions, find compensatory strategies, build on strong functions
  • Never generalise, children with CVI are highly individual in their functions and experiences. Consider other impairments.
  • Consider techniques of blind people.
slide70
CVI
  • Impaired cognitive vision is most often part of brain damage related visual impairment that involves also motor functions and/or hearing.
  • When CVI occurs without other neurologic problems, it is often wrongly diagnosed as ”autistic features” or the child is said to see ”when (s)he wants to see”.
our goal71
OUR GOAL

to understand each child’s

visual functioning

visual impairment73
Visual Impairment

Basic questions:

How does vision affect this function?

How is vision going to affect development of this function?

Does the child have compensatory techniques? How do I teach them?

How do I help the child to develop compensatory techniques?

vision for special education
Vision for Special Education

- consider ALL areas of functioning at preschool and school age

not only

- vision for academic subjects

slide75
Vision

is

a learned function

learning to see
Learning to see

Hands (to midline and into mouth)

Mouth (a reliable source of information)

Tactile information, tasting, smell

Vision (confirmed by other modalties)

Multimodal memory

Recognition

slide78
Because

vision

is

a learned function

start early intervention early!

slide79
CVI

Cerebral visual impairment

Brain damage related visual impairment