2 Orientation & Mobility What is orientation?It is the ability to know where you are in space. This includes the knowledge of where you are in relation to objects, in relation to ones self, and where one object is in relation to another object.
3 Orientation and Mobility continued: For children with CVI orientation and mobility addresses making adaptations based on the 10 characteristics of CVI.Adaptations are paired with providing environmental prompts with natural landmarks.When working on O&M with children with CVI ocular visual rules do not apply; O&M is not about acuity, increasing light, providing contrast, or about stable items.
4 Orientation & Mobility continued: With CVI students, O&M focuses on salient characteristics using color, novelty (how something is like or not like something else), and complexity.Often children in Phase III of resolution may require the use of a cane.Children in Phase III may have difficulty noticing descending stairs, drop offs at curbs, managing uneven surfaces, or handling surface changes.
5 Phase III Assistive Technology Ideas: Computer SoftwareSwitch activated toys/devices if motor skills are an issueSwitch activated or touch screen computer accessCommunication devices beyond single step communication devices (if communication is a concern). When using a communication device it is recommended starting with a device which has a back lit display.
6 Phase III Helpful Hints Consistently present objects in routine activities to develop visual memory.Just because a child has looked at a particular object in the past does not mean they will automatically look at it when it is presented again.Routine, touch, familiarity and interest help to initiate visual attention.When using a computer the material can be enlarged or screen reader programs can read the passages aloud.
7 Phase III Helpful Hints continued: Use verbal prompts to direct the child to look (i.e.: look at the red ball).Teach organizational skills such as how to scan a page to solve a problem.Use larger size fonts for written items.When working on literacy, even as simple as basic letter recognition, use fewer words on a page, color code or outline the entire word, and add color outlines to pictures to help child attend visually.
10 Phase III Helpful Hints continued: Use verbal strategies to assist child in using vision. Explain what the child is looking for. With verbal explanations the child can use their cognitive skills to assist in using their visual skills. For example, Sally in The Cat in the Hat always has a red bow in her hair. Use that feature to help the child look for Sally in pictures. In that example the salient feature of the character is the red bow.Use of salient features are key in Phase 3 or resolution.
11 Phase III Helpful Hints continued: When a child is ready to look at pictures, use pictures or simple books that have one object on a page with a plain background.Take pictures of familiar people and toys/items to make a simple picture book.Be sure the pictures have a plain background.Initially present one picture on the backgroundGradually add detail to the picture and ask the child to use the salient features to find specified items.
15 Phase III Helpful Hints continued: Begin with pictures of familiar items.Point out the salient features in the environment. If in school make sure hallways are empty. Use picture cards in conjunction with the review of the environment.Identify bright colors and naturally occurring landmarks in the environment.
16 Phase III Helpful Hints continued: May need to go back to older, “easier” supports to give the child’s visual system a “boost” (i.e.: when asking the child to locate items in different environments.)Try to incorporate use of vision into as many aspects of the child’s day as possible – a person with dentures doesn’t only wear them when they eat, or a child with glasses doesn’t just use them when the vision teacher comes to see the child.
17 Phase III Helpful Hints continued As noted in Dr. Roman-Lantzy’s book Cortical Visual Impairment: An Approach to Assessment and Intervention, instruction in Phase 3 generally has 2 key themes:teaching sorting skills with reference to the concepts of alike and differentdisembedding salient features from a background.
18 Helpful Hints for all Phases of Resolution: Always give the child time to respond; at times this time period may seem “beyond reasonable”.Make changes in the environment slowly.Repeat, repeat, repeat!!!Use the familiar to introduce something unfamiliar.Allow the child to have rest breaks; using vision can be tiring!
19 Helpful Hints for all Phases of Resolution continued: Use observation and let the student “tell you” what they do best and guide their progressAlways remember to point out the salient features/characteristicsMake sure to always consider the child’s positioning when asking them to use their visionWork in an environment where type, intensity, and duration of sensory information can be controlled.
20 Writing outcomes and goals: Make sure functional performance is included in the child’s goals.Goals should not be written for a child to “look at” or “visually track” an item in isolation. What functional purpose does this serve?Goals should relate to what the ultimate end result is for the child.
21 Sample IFSP/IEP goalsSam will be able to move from room to room in his house on his own without running into things so he doesn’t get hurt.Sally will look at, reach for, and play with toys so she will not be as fussy.John will see a toy across the room, crawl to get to the toy, to play with it and entertain himself for short periods of time.Julie will navigate the playground equipment safely using all visual fields to play with her peers during recess.
22 Sample goals continued: Very often individual goals do not need to be established simply for CVI or vision; instead modifications to the child’s curriculum, environment, and activities could be incorporated as a means to support the functional outcomes.