Some key points and reminders on the understanding of CVI children's learning and vision; and interactions of teachers, therapists, trainers, carers, and parents with CVI children.
Chinese version: https://lowvisionandcvi.blogspot.com/2017/11/cvi.html
Key points in this article:
1.It is
difficult to have a clear and full understanding of the visual ability of
children with CVI (cerebral visual impairment/ cortical visual impairment).
2.Visual
problems are affected by a list of factors, how could we understand the visual
problems of CVI children?
If CVI
children have multiple disabilities or severe intellectual disability, or
severe physical disabilities, their means/modes of expressions might be
restricted. As a result, they could not give the appropriate responses. In
other words, no response or incorrect responses do not imply that they could
not see, have no sensations, have low learning ability, could not think
properly, have no memory, or no interest …
3.Imagination
and memory are very important, but they need meaningful experiences to build
up.
4.During
teaching, training, therapies, and services, CVI children should establish
relationships with people. This is more important than making contact with
objects.
5.Teachers,
therapists, service providers and parents should try to elicit CVI children’s
responses from the social-emotional perspective.
1. It is difficult to have a clear
and full understanding of the visual ability of children with CVI (cerebral visual impairment/ cortical visual
impairment).
For CVI students who have deficits in visual
performance due to brain damage, I always think that it is really difficult to
understand what kind of ‘picture’ is the image that the student is ‘perceiving.
What is the difference between their perception and the perception of people
with normal vision?
As the aspects of vision (e.g. visual acuity, visual
field, contrast sensitivity, binocular vision, night vision, color vision,
intra-ocular pressure, muscle control, sensitivity to lighting etc.) are more
than the aspects of hearing, and as these aspects interact with each other,
even ophthalmologists or optometrists could not accurately evaluate the various
aspects of vision in children with CVI.
What’s more, if the child has intellectual disability,
then there is an additional factor that multiplies the difficulty of accurate
assessment results. We could never be sure of the reasons that account for
incorrect responses of CVI children, e.g. was it because he couldn’t see or
because his brain had difficulty in processing the particular visual
information, or whether it was due to intellectual limitations, so he could not
understand the instructions or could not give the expected responses, or
whether he was afraid of unfamiliar people, unfamiliar environment, not
cooperative, was not willing to show his response, or whether it was due to
limitations in his fine motor (movement and control of his hands and fingers).
2.Visual problems are affected by a list of factors, how could we understand the visual problems of CVI children?
To us, it seems that CVI children who are ‘looking but
could not see’ have weak abilities or even without response. But no response
doesn’t always imply that they could not see. Maybe the reasons are that they
could not give response or any indication. Thus, it is only through the
establishment of a close relationship with individuals and through long term,
detailed and repeated observations, analyses, and inferences, that parents,
teachers, and caretakers could understand them more.
3. Imagination and memory are very
important, but they need meaningful experiences to build up.
What the film ‘The Diving Bell and
Butterfly’ indicates to us
'The Diving Bell and Butterfly' was an Oscar Award
Film, which was based on a book about a real subject. The subject was a
renowned editor of a French magazine. He suffered stroke because of a car
accident. As a result of the accident, this man could not move his body, as if
he was confined in a diving bell. He could not express himself, nor could other
people understand him. Although he still had a lot of feelings and thoughts
running in his mind, his body was confined physically. Moreover, the
confinement was severe. Although he still had sensations and thoughts, nobody
bothered about him.
Later, a speech therapist discovered that this man
could use different blinking patterns of his eyes to represent the French
alphabets, and this mode of expression had opened a means of expression for
him. In fact, he still retained his intellectual ability and his brain was
still working. He ultimately wrote this book about what he had learnt from his
unusual experience of being a healthy person initially but then turned into a
totally confined and impaired person.
I encourage people who work with severely handicapped
children to read this book and understand the 'internal world' of people who
are physically restricted and severely confined. The author of the book had
made one remark that was very touching and inspiring, “At least, I still have
memories and imagination.”
Memories
Why are memories important? For life is comprised of
the ability to remember and memories of the past. However, if there is no
experience, how could there be memories? Memories are one interesting aspect of
human beings, as what have happened would be kept in a certain part of the
brain. The question is how to retrieve memories.
Therefore, it is very necessary to form memories for
severely handicapped children like children with CVI, especially
multi-handicapped children. For if they are already being confined visually, we
should help them form emotional, sensory and tactile memories instead. But
surely, the experiences that are provided to CVI children should be meaningful,
in order that memories could be formed, instead of incidences linked together
that have no reason or meaning.
Imagination
Imagination is also another very amazing aspect. If we
lack imagination, we will suffer great pain. Because if we have imagination, it
is like a window that is opened in order that thoughts could be freed. For
children who are severe handicapped, do they also have imagination? I think
they surely have. For only when they have memories, could they correlate with
‘a picture’ (situation) in their memory, whether it is a visual form of picture
or auditory form of ‘picture’, or the smell of people and the environment … No
matter whether the ‘picture’ is vivid or blurred, this particular picture
(situation) would be formed in their memories. Although we could never know how
they could see or what they have actually seen, I believe that their feelings
are very real.
4. During teaching,
training, therapies, and services, CVI children should establish relationships
with people. This is more important than making contact with objects.
For CVI children whose visual abilities are weak, they
generally seem to have greater reactions and interests in objects. But in fact,
people should be more important than objects. They need not make contact with
lots of objects, but the top priority in their experiences should be in contact
with people. When they have feelings toward people, when they have the
motivation to communicate and interact, then wahen people introduce objects to
them for learning, this would be faster, easier, happier, and more holistic.
Therefore, no matter mild or severe intellectually
disabled children, if the people that the individual child has contacts with
are people that he/she likes, he/she would learn a lot faster, better, and with
higher motivation. If teachers or therapists in the classrooms do not interact
with the child when giving an object to the child but just describe it, the
child would actually find it difficult to grasp the meaning of the description.
5. Teachers, therapists, service
providers and parents should try to elicit CVI children’s responses from the
social-emotional perspective.
Particularly for visual training in the past, people
assumed that CVI children have difficulty in receiving different sensory inputs
at the same time, or that complexity in the environment would affect the CVI
children’s concentration. Consequently, training often takes place as the
visual stimuli were presented to the child without description or auditory
input. Such a training style might have helped CVI children to concentrate, but
lacks the opportunities for the child to have emotional interactions with
people, which subsequently lowered their motivation in learning/giving
response. What's more, the CVI child may not be able to understand what is
happening and so he would not respond.
Therefore, teachers, trainers, therapists, caretakers,
and parents should beware of this and the top priority should be given to
developing relationship with CVI children, especially close and caring
relationships, and try to elicit the responses of CVI children from the
social-emotional perspective.
Remarks:
1. The
above ideas and key points are originated from an experienced special
educator’s experience sharing. I’d like to take this opportunity to express my
grateful thanks.
2. There
is another article in this blog that explains the learning characteristics of
CVI children with multiple disabilities, as well as the teaching strategies and
general guidelines with regard to the care of CVI children.
