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TRANSCRIPT PROVIDED BY CAPTIONACCESS LLC support@captionaccess.com - - PDF document
TRANSCRIPT PROVIDED BY CAPTIONACCESS LLC support@captionaccess.com - - PDF document
TRANSCRIPT PROVIDED BY CAPTIONACCESS LLC support@captionaccess.com www.captionaccess.com University of Maryland CBSS Cortical Visual Impairments: Materials Friday, April 10, 2020 * * * * * This transcript is being provided in a
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- presentations. I'm going to talk about some general ideas for each phase.
Then I go through characteristics. The main reason this isn't being recorded is I have lots of kid pictures, which I think keeps it interesting. When you think about intervening with child, we always start with
- assessment. The CVI range is for kids with CVI. You don't do functional
assessment with a kid with an ocular impairment along with CVI, CVI is the
- assessment. This will give us a score of 0-10. I have never seen a 0 or a
10. Kids in phase 1 are somewhere around 0-3, phase 2 is 3-7, phase 3 is 7-10. We have to know what we're doing in each phase. In stage 1, we want to build stable visual functioning. I want you to look at thing. In phase 2, we integrate the vision with function. We want to use vision in all of your routines throughout the day. I have a thermos of water. I did consider wine but went with water. Phase 3 is where you see children using visual curiosity and can use their vision for learning. Now they can look in order to learn about things. Phase 1, we're going to build stable visual function. This takes a high level of environmental control. Sometimes that means lights out and no other noise. You have to plan times of the day when children can practice without other
- demands. This is unlike the other phases. With phase 1, when those kids
are looking, looking is all they can do. You can't have them looking in the context of PT or their meal or circle time in school. You have to make sure there are times of the day when the child can practice vision and there's no
- ther demands put on them. I tell families, are they in their crib, adaptive
seating? Place something you know they will look at. I use downtime for vision activities. If the child is tube fed and they need to be seated upright due to reflux or during tube feeding, then that's a good time to give them something to look at. Create a box of toys. Things Eric will look at. Eric is a random name. You create a box of
- bjects; this is what we're going to practice with and nothing else. We use
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single colored objects. That means that the objects are all one color. Sometimes that also means there's only one color the child will look at use characteristics of the familiar to introduce something new. If we are going to introduce something else, if it's red and moving, the child may look at it. Make sure the items are close and you have no color in the background, typically black. You allow the child to focus visually without talking to them and without sound in the background. That's a challenge in a classroom. It can be a challenge in a home situation. Now all my poor babies have siblings at home. It gets really challenging. You present objects in the child's preferred visual field. If they will look at things to the right, then you put it in the right. You move objects slightly to get them to look. You use reflective materials. You use light, maybe to initiate looking at object or target. Sometimes I'll shine a light on
- something. I'm moving the light. You place objects where the child can
look and/or touch. In phase 1 we may not be expecting the child to look and touch, but if we can position objects where their hand will accidentally hit it, what we're hoping happens over time is they learn to do that purposefully. I see people use lava lamps; you can get those online. You can get rope lights around the holidays or 4th of July. I like rope lights because if the child touches them later, if they pass phase 1, if they bring them to their mouth, the lights are covered by rubber, so it won't hurt them. I had one family that put a lighted red heart by the child's bed. Mylar balloons are awesome. Typically, we make a frame out of plumbing pipe so you can suspend toys and they move. We use pegboards. I have pictures of all this later on. Wind socks are good because they naturally
- move. Tri-fold boards are the presentation boards. They are move
expensive if they're foam but you can get cardboard. If it's cluttered, you can put up the tri-fold board. In phase 2, now we're going to integrate vision into all the child's routines. For each routine we will think about what we can do to encourage the child to look.
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The intervention is not a separate time of day but an overlay in all activities. You plan the vision component of the beginning, middle, and end of all
- routines. With feeding, I have a red spoon. I'll pause and move it and
wait for you to look. Once you look at the spoon, I'll give it to you. You use all the objects you use in phase 1. We got a child to look at something red, now we will put something red on their cup or bottle so they can use vision in those routines. Maybe you put mylar or shiny materials on switches. Limit the number of things you put out at one time. Kids in early phase 2 are just starting to look at things. If too many things are out, it's way too complex. A lot of times we'll use a lightbox. Now we want you to look a little further away. The thing you liked? We will hold it further away and see if you notice it to get some more distance vision. By phase 3, we have curiosity and using vision for learning. At the end of phase 2, when they are visually curious and they go, "what did you bring?" That's visual curiosity. You also see more spontaneous use of vision. In phase 1 and 2 we have to align the stars. By the end of phase 2 and in phase 3, we have kids spontaneously looking at things in front of them. Now the child can look at themselves in a mirror and look at and understand pictures. Pictures are critical for communication, literacy, all kinds of things. Even my high phase 3 kids, this year I have a number of kids who are academic who have CVI, and they still have problems in new
- environments. Novelty is forever really tough. Particularly when the
complexity is high. Remember the preferences they had in color movement? If we're going to get a child to do something really hard, maybe we outline words or put things on a lightbox. Maybe we're going to use an iPad. Highlight words with color, I said that. We use color as an anchor for visual understanding. I can say we're looking for the stop sign. Or, Becky would say that. It's
- red. Now we can use color to let kids know what they're looking at or for.
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We highlight communication symbols. I don't mean we put a red square around it. Color tells me where to look. If you outline something, I'm going to look at the outline and not the symbol where you want me to look at. We will use color on the symbols where we want the child to look. We will give a visual cue with an auditory
- cue. We preview environments and teach landmarks. We preview
- textbooks. We preview the textbook so that they know the visual part of
that story before the teacher reads it and is asking comprehension questions. We tell the student what they're looking for in a visual display. We're looking for the frog, the frog is green. If the child is not looking at something always review complexity. That's actually for all phases. Complexity is a huge thing. We use movement for distance viewing or scanning choices. Sometimes I have people point to where they want the child to look on the work page, and the movement helps direct the
- attention. We use templates to reduce complexity in 2-dimension arrays.
If things are always in the same place, I have one kid learning to count,
- ne-on-one correspondence and learning to count gets real confusing
when the materials are in a very random array. I always use a template of putting things in a certain order to make sure he's more accurate in
- counting. We always have to teach salient features. How do I know this
is a picture of a dog and not a cat? I don't know why this says phase 2. I was changing things around right beforehand. Let's shift gears back to phase 2 because I put the slide in the wrong place. It's Friday and I promise this is water. Sometimes touch may initiate looking. It lets them know what I want them to pay attention to. I'm using familiar objects in daily routines. We will pick an object in every routine that they see every
- day. The same spoon, cup, object for bathtime, etc. I've had families use
bright colored sponges or a yellow shampoo bottle. We use the same
- bject, so they become familiar in the daily routines.
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Sometimes if you shine a light on something, I find that true when I'm trying to get a child to pay attention on a page. If I shine a light right where I want them to look, I have a better chance of focusing their attention on that spot. Introduce photos of favorite objects. The end of phase 2 is when you're getting your first books. That was only one slide
- ut of place, yay! This is straight from Dr. Roman. It has to be in the
context of every day for the child. Often times you have children doing better at home than school. We have a new setting, a more complex setting, new people, a lot of clutter in most classrooms. This is the hardest
- ne for teachers.
For CVI, you provide visual input at the child's level and not above. We to be convinced that they can handle it. Not that you don't try something a little harder. The input has to be where the child is. It's an approach, not a therapy. It's a way of presenting materials. It's not a standalone
- therapy. Now is where we get the cute pictures coming in. For color, if
we go by characteristic, we will use the favorite color. They may ignore black and white. Use color as an anchor. Make a box of favorite things. Use color with functional materials. This is an example of a phase 1. Isn't Chris cute? This is Chris like Elmo. When he was in his chair, he needed something to look at. All I'm expecting him to do in the chair is look at
- Elmo. This is actually Chris. We have lights and shiny materials and his
favorite color, red. He's fully supported. We don't expect him to do anything but look. This is another phase 1. The only thing Katherine would look at is shiny and red. If her hand moves, it will hit the ball. It actually did. I'm always thinking about what I will want them to act on in phase 2. She has to be tube fed and sit in her chair. She actually raised her arm and hit it. Too
- cute. This is Keith. This is phase 1. He liked his shiny, red balloons.
While in phase 1, they struggle with assessing kids impacted with multiple disabilities such as look and reach with limited movement. If they don't have movement, you don't score that item on the test. We don't want to penalize them when we don't have the ability to look and move their arms
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at all. If they have any movement at all, I like to position things where they can look an possibly act on it. If I go back to Katherine, she had very limited movements. If you see how close that was positioned to her, I don't remember if I scored visual motor. She typically did not reach for anything. I'm setting it up if she has any
- pportunity to bat at something. I might tie a balloon to the child's wrist
so if he moves his arm at all. If they don't have the ability to move, we don't score visual motor. We have to teach them that looking at something is acting on it. With some of my kids, they will look at Little Bear and when they see it, then the adult touches it. We are giving them the opportunity to understand that they can make things happen with vision even when their hands don't work. How would you adapt the score to not penalize them? I would say they scored a 2 on a 9 point scale. It's typically 10 points but we're making it a 9 point scale. People are also mentioning eye-foot instead of eye-hand. Yes, awesome. This is more of a phase 2. Bryce's favorite color was blue. They put translucent blocks
- n the lightbox and his job was to reach them and even knock them off.
They got his attention to that lightbox with the blue. This is a phase 2. We want the kid to look and reach and take the pegs out. Same thing
- here. Putting in a bowl.
This is Elijah. We were trying to get him to look and reach. Yellow and gold had been his favorite color from infancy. We've used color to make the vision easier. Now I'm asking him to do visual motor. This is more of a phase three. There's the outline in the child's favorite color. This is prior to the Bubble App. This could also be more of a phase 2 or 3 if I'm asking them to match or sort colors. Again, I'm using light or color. We can use color even as the child is moving into pictures. If you were asking a child to-, you know in kindergarten you have to track along, we can use color to help the child find the H's much easier. The next characteristic is movement. Most of the time, kids detect movement with their peripheral. We hope
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they fixate directly on the object. They may just orient. Reflective objects have a movement quality. Mirrors are reflective but you have to watch
- complexity. You guys see what's behind me, this is a disaster for a vision
- teacher. We use things that naturally move. Pat-mats like the Ziploc
bags you can put gel and colors in, I always move toys to get a child's attention if they're not looking. I have a hard time not moving things because I'm so accustomed to it. If I want you to make a choice between two things, I'll make sure you look at
- both. You use movement to encourage distant viewing as well. This is a
phase 1 intervention. She did not have movement in her arms. Her mother put up shiny things no matter where she was. She had a million doctors appointments. She had a pinwheel on her wheelchair. This is an example of using shiny, moving things. This is a homemade wind sock. I just snapped this photo, it wouldn't be presented with this much complexity in the background. The teacher just used a hoop and
- streamers. That's the balloon. This was a disco light. This is more of a
phase 2. Bryce liked to look at the lights move, but there was a switch for him to
- press. This is also phase 2. We want Keith to use his hands. We use red
and shiny. The bead certain is just made with pegboard and beads
- attached. It's right where his hands move. When he kicks, it also moved.
This was a great phase 2 activity. She had very little movement in her
- arms. You see the little yellow head switch. That operated the fan that
blew on the shiny gold palm. This is a phase 2 activity. We made a book for Kendall to look at with her mother. We used shiny foam shapes. This is an activity set up by a teacher. This would be phase 2 or 3. They wanted the kids to look at the movement at a distance and move over to the fish tank. There are lots of CVI adaptions here. Visual novelty. We use the characteristics of what kids will look at to introduce new things. I had one teacher that found out that when she wanted a kid to use their vision in the context of breakfast. She set the kid up with shiny red lights
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which was below where the kid was, but it got the vision system kickstarted. He did better when they had him looking at the spoon or reaching for it. If it's important, we want the same thing presented. We don't want to new toy everyday. You highlight novel things with familiar color. Remember that redundancy is not boring. For a child with CVI, once they've learned to look at something, it's not boring for them. Once you find something the kid likes, leave it. Don't change it the next
- day. This is a phase 1, phase 2 situation. Elijah would look at his yellow
ducks as a baby. For something new, we used the characteristic we knew he would look at. Jenna is looking at purple. Her sister loved purple. The movement quality she liked, this was an activity for a kid with very limited movement. She had spastic quadriplegia. Any movement of the hand moved all of those bells up there. This is also Jenna looking at the bright pink. She more use of her arms on her back. We're using shiny and pink and purple. This is Keith. When we introduced a new activity, we used the color red. Hold on one second. I just had to give an updated picture of Keith because he's too cute. Latency, wait, wait, wait, wait. I can't say it enough. It will vary across the session, whether it's something novel, what color it is, fatigue, maybe I'm hungry or had a seizure, maybe I'm getting a cold. Positioning impacts
- latency. Always think about latency. That is Elijah.
This is set up for Jack. It's kind of a phase 1. We set it up so he can take all the time he needs. Same is true for this activity. This is an interesting
- activity. They were trying to get the child to pay attention and moving
toward teaching 2D symbols. By putting it on the wall, instead of just sticking out two switches for the kid, they left it on the wall and allowed as much time as the child needed to think about it. Then they would make the choice. If they hit the picture, then they would take the thing down and give it to the child. Light gazing. You can use it as a motivator. You can use backlit things such as iPads. Be careful about multi-sensory.
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For kids that really are distracted by light, position them so their back is away from a window. One teacher had a kid that was a real extreme light
- gazer. They had the maintenance people in one corner of the room, they
unscrewed the overhead lights. They had a corner where they could work with him without overhead lights. This is a phase 1 activity. These are press on lights with plastic cups. A teacher shining a light on the toy. This is Alexandra. She would only look at lights. We took her bouncy seat and would drape something black and hung it up for her to look at. This is a kind of phase 1 and we're hoping to be phase 2. We have his hands there. We hope he will move his hands some. Somebody did this on a light box where you cut a circle and it looks like the light is shining throughout the ball. I don't know if you're familiar with Diane Cheline [sp?] She takes press-on lights and hot glues a slinky. You see Aaron looking at those. It looks like the slinky is lit up. This is one of those pat-mats on an iPad. Pegs on the lightbox. Backlit surfaces. This is a touchscreen computer activity. iPads, of course. Field preferences. You have to present objects in preferred fields. If they have only a left field, they're only going to see that one. You position the child in group activities so their preferred field is toward the teacher and peers. This is Jenna showing we don't want things in the lower visual field. This child had a stroke after heart surgery. His teacher is positioning on the left because he has field loss on the right. Complexity is the biggest thing. I'm a good example, what's on the wall behind you, what you're wearing, tri-fold boards, limit multi-sensory toys, you might need a more supportive
- position. I have a child right now that barely looks at faces but he does
the best laying on his back. Greet and then be quiet and give the child time to look. Faces are very complex. I have seen trays covered with black cloth. One mom used a pillow case. If you're working on something more complex, then you want the vision to be easier. Don't have too many toys out at
- nce. Use the child's verbal skills. Simple pictures, one per page. We
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have to describe the salient features of objects. If you're doing written information a page, sometimes we have large print not for acuity, but because it's less cluttered. Keep the workspace uncluttered. Remember, hand over hand prompting increases complexity. I've never seen a child that if I do hand over hand they don't immediately look away. This was a tri-fold to reduce complexity. Elijah's mom put a pillowcase over his tray so then she could wash it. Pictures are more complex than objects. It didn't have to be that big but they made it that big. Pictures of things a child knows. Photographs are easier than cartoons. These are some
- symbols. This is why you have to use matte lamination. If you don't
laminate them they will scrunch them, drool on them, etc. You need
- matte. The picture of the CD is laminated in shiny. Here, he's working on
an oral motor task. His face is the only thing in the mirror. This is simpler than this because it only has one color. This was a workstation in a classroom. They put up some big dividers. This is from Doctor Roman's book. We've got multiple colors here. All of this, even if you cover half, you have silver and red and white. Watch complexity. This was a task an OT set
- up. This child loved his water bottle. Those are Velcroed on. These
were set up in a classroom. I think they meant well. If they look up, there's way too much on the wall. If you're at one of these, you have the trim around the bulletin board. It's still very complex. That's a tri-fold, they were working on words. This was an interesting adaption. This child didn't like baby books with
- ne picture. The book her peers were reading was about spaghetti. They
took a photo of spaghetti and a couple of photos from the book so she could have the same book her peers had. If you look at some kid books, like Spot is an easy one. This is a child's schedule. I want you to notice that it's never all or nothing. This child knew faces. The faces represented speech and PT. Then there's a photograph of daddy. This was very complex. Symbols are more complex than photos. For
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bathroom, I always teach this symbol. It's what kids find in the
- environment. Toilets all look different. This is a very complex array. You
see that there is color highlighting. The yes and the no are apart and one is clearly green and one is clearly red. This is black in between and there's also a cover to this. If you think about going into the community, let's find bananas today. Oh my goodness. Distance is a function of complexity. Think about finding something at a distance and how much complexity there is. Distance begins with large moving targets. Use movement, favorite color, favorite toy, preview environments when there's going to be a lot of
- information. Let the child understand it before they're asked to function in
that environment. We have about 10 minutes left. I think I'm getting close to the end. I'll stay later if anyone has questions. Clearly you can see the pillow up close. This was created in a hallway. They wanted a child to look at a distance. That is distance. If I'm going into Walmart to find toilet paper, that's a very complex task. The last one is visual motor. The child may look away and reach. You position objects so the child can act on them. Use
- bjects that move when the kid accidentally touches them. I've use mylar
billions to attach to their arms. Sometimes you get a nice look and reach if the thing is familiar. This is Bryce. This is Kendall looking and reaching. She is not looking while reaching. That's Elijah. I wanted to show this because there would be no way to look at that stuff and reach for it. Anything in the lower visual field is probably not available to her. Even though that brush is modified nicely, it's not available to her. That's why we had to have things up. Again, the bells that are gonna move are in her upper field. This is the challenge for kids with motor impairments. They cannot get their hand up in the same visual plane as the thing they're
- touching. Then, like with this, we got creative and her hand is down. As
she moves her hand, all of these move. She's doing it even though she can't see her hand and the object at the same time. This was visual motor.
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They wanted him to look up and look and reach. This is also visual motor. This child was using some symbols. Once we go, are we gonna walk, go in the car, I don't know what the next one is. Maybe the trampoline. Go on the bus, go on the bike. Questions? Sandy, while you're talking about visual motor, somebody made a good comment before. For kids who can't look and reach independently, can we score that when we touch the
- bject? I don't know if you want to comment on that. We just don't
score it. I often find that for those kids that can't look and reach, say I've got a slinky or something and they're looking at it really well, as soon as I touch it to their hand to see if they will grasp or do something, they almost always look away. If they can't reach at all, don't score visual motor. If they know that their hand moving is affecting something they're looking at, I like to try to set things up with that. Other questions? Bye! Are you seeing that? As a classroom preschool teacher moving to distance learning, what would be some good resources to share with the families as I teach? I would think some of the Perkins things are really good. Perkins eLearning CVI hub. The department of education and Dr. roman has a
- blog. She's been sending out ideas of things to do with your child at
- home. Things in phase 1, 2, that kind of thing. Are we connected to her
blog on the website? Good question. I'll ask Jenny, if not, I'll make sure that's available on the
- website. Perkins and West Virginia are the places I send people first. I
feel they have good parent information and it's good quality CVI
- information. The project coordinator from the New York product is