RUNNING HEAD: HELPING STUDENTS WITH CORTICAL VISUAL IMPAIRMENT

Helping Students with Cortical Visual Impairment

Technology and Techniques

Victoria Dickens
3/20/2012

HELPING STUDENTS WITH CORTICAL VISUAL IMPAIRMENT

2

Abstract
This literature review compiles, analyzes, and synthesizes information regarding technology and
techniques that have been used for students with Cortical Visual Impairment (CVI) to argue that
these students need technologies and trained staff in order to ensure success in the classroom.
Not very many studies have concentrated on students with CVI, but the research that has been
done, such as Braille interventions, using color and motion, CVI Range, and micro switches or
assistive technology (AT) devices all appear to be effective in the classroom. Braille, enlarged
texts, text readers, writing assistants, assistive technology for writing, and color coding may help
a student with CVI to adjust and succeed in a classroom environment. Inclusion for students with
CVI remains a controversial topic with more professionals suggesting that a normal classrooms
pace and setup may overwhelm a student with CVI. More research needs to be conducted
concerning students with CVI and interventions so that teachers and parents know reliable and
systematic interventions proven across many studies.

HELPING STUDENTS WITH CORTICAL VISUAL IMPAIRMENT

3

Helping Students with Cortical Visual Impairment

Though Cortical Visual Impairment (CVI) affects few students, the students that do
struggle in school due to this disability deserve more resources and research so that teachers will
be able to provide the most appropriate education available. Very little research has been
conducted regarding CVI compared to other disabilities such as Autism or Emotional Behavioral
Disorders. This topic intrigues many professionals not simply because Cortical Visual
Impairment can be a complex puzzle with many different facets and contradictions; underneath
this mystery, one must wonder how life would be different if the sense of sight was diminished
or nonexistent. How would the world be different if the only way to take in surroundings was
through sound, taste, touch, and smell? These students live with a visual impairment, and
observers of students with this disability cannot help but wonder what one day would look like
without vision.
Clinical reports note that certain characteristics accompany CVI which distinguishes this
disability from other students who are visually impaired or blind. Light gazing, photophobia,
eccentric viewing strategies, nystagmus, scotomas in the visual field, and unsteady eye gazing
are all characteristic of students with CVI (Swift, Davidson, &Weems, 2008). While most
professionals agree about the signs and behaviors that accompany CVI, color preference remains
a subject of debate. Many studies claim that yellow is preferred over other colors, but one study
in particular argues convincingly for the flaw in that claim (Cohen-Maitre, & Haerich, 2005).
During that study, children with CVI were shown two screens, and on each black background
was a bar of either grey or a color that was moving or still; this study proved that students with
CVI preferred movement over color and that between green, blue, red, and yellow, there were no
clear color preferences. Children with CVI have normal color vision because these areas are

HELPING STUDENTS WITH CORTICAL VISUAL IMPAIRMENT

4

more spread out in the occipital lobes and they are relatively spared from the damage that causes
CVI; these children also identify objects by color, texture, smell, taste, and not by shape or form
that they see. Many children with CVI are preverbal or lack verbal skills, they look away when
reaching for an object, they experience vision field loss, have difficulty with distance, difficulty
viewing novel objects, and visual inattention problems (Newcomb, 2010).
Though there might be few resources regarding this topic, a few themes continue to stand
out amidst all the research conducted. Assistive Technology is completely necessary if a student
with CVI is going to grow and succeed in an educational setting, at home, and in the community.
Assistive Technologies help students access a curriculum that would otherwise remain
unattainable; technology allows students with visual impairments to learn information through
auditory processing, through touch, and through modifying visuals. In one case an AT device
that allowed character entries through selecting options of character strokes which allowed a
student with CVI that could not write well to express ideas through typed language (Leung,
Yates, Duez, & Chau, 2010). Switches can help serve the purpose of communicating since most
individuals with CVI have trouble with verbal expression, and Braille seems to be a common
theme when teaching a student who is visually impaired (Creech & Golden, 2009). Larger texts,
screen synthesizers, and screen readers give student with CVI equal access to information or
research for a class and can help a student with CVI have access to information and educational
materials (Alves, Monteiro, Rabello, Gasparetto, & Carvalho, 2009). Educators need to be
knowledgeable about CVI and know how to support families and students because few special
education programs instruct future teachers on this impairment or teach techniques that could be
of a resource in the future for teachers (Jackel, Wilson, & Hartman, 2010).

HELPING STUDENTS WITH CORTICAL VISUAL IMPAIRMENT

5

In the classroom teachers should have the student moving frequently throughout the
environement (Cohen-Maitre, & Haerich, 2005). For educators it is more important to measure
functional vision, or how that student uses vision in the context of daily tasks (Newcomb,
2010); that way the teacher will know how to best utilize that students talents. Educators should
also consider whether inclusion really is the best solution for that student because the least
restrictive environment must be the one in which the child can gain the highest level of
educational and social benefit (Swift, Davidson, & Weems, 2008). Sometimes the normal
classroom is the best place for a student, but many students with CVI have comorbid disorders,
need more explicit instruction, and might find it frustrating to be in a class where their peers can
go through the work much faster. Visual crowding and overstimulation found in typical
classrooms would distract a student with CVI; in addition, there may be limited explicit or direct
instruction. Fluctuating alertness and visual fatigue can affect how that child experiences the
inclusive classroom. Teachers should develop patience and allow the child more time to respond
in an academic setting because students with CVI usually process a little bit slower than their
peers; students with CVI can perform on grade level, so they are not suffering from an
intellectual disability unless that is a comorbid disorder, but these students do need a little bit
longer to process and produce work in the classroom.
Great resources for teachers are readily available, such as the American Printing House
for the Blind which is an organization that provides educational materials for students who are
visually impaired or blind. Throughout the studies and surveys done, however, teachers do not
resource themselves as they could or should. There is the I-M-ABLE four-year program to
teach a student Braille through submergence into a Braille-rich environment followed by explicit
connections and instruction (DAurizio, 2011). Machalicek (2009) also advocated Braille as a

HELPING STUDENTS WITH CORTICAL VISUAL IMPAIRMENT

6

wonderful accommodation for students with CVI, as many other educators. Assistive
Technologies are also available that ease some stress off of teacher and the student (Erickson,
Hatton, Roy, Fox, & Renae, 2007).
Parents of students with CVI must do some research and implement some supportive
structures at home. At home parents should use consistent colors for important objects such as
setting the table with the same color cup every night so that the child can associate that color
with that object. Many times children with CVI cannot distinguish shape or form, so by making
certain objects consistent that child will know how to use each object. Parents and teachers alike
should be careful to not over stimulate the child with too much color in the environment because
the child will feel overwhelmed if too much color is present at one time (Cohen-Maitre, &
Haerich, 2005). Parents should not crowd the visual field because that will cause unneeded stress
for the child (Swift, Davidson, & Weems, 2008).
Students with CVI benefit the most when educators, doctors, and parents are informed on
the topic of this disability and the many disabilities that can accompany CVI, such as epilepsy,
cerebral palsy, and central nervous system infections (Swift, Davidson, & Weems, 2008). The
research clearly paints a picture of a healthy environment for a child with CVI, such as making
sure that certain items are color coded and that the environment is not saturated with too many
colors, which can overwhelm the child. Depending upon the child, Braille or large text should be
introduced at school age if another disability does not cause the child to be developmentally
delayed, and teachers should be careful how they integrate a student with CVI into the
classroom, especially in the early grades when students are just getting used to school. More
research needs to be conducted with more interventions so that educators, parents, and
professionals can create more effective interventions for students with CVI.

HELPING STUDENTS WITH CORTICAL VISUAL IMPAIRMENT

7

References
Alves, C. C. F., Monteiro, G. B. M., Rabello, S., Gasparetto, M. E. R. F., & Carvalho, K. M. D.
(2009). Assistive technology applied to education of students with visual impairment.
Pan Am Journal of Public Health. 26(2), 148-152.
American Printing House for the Blind, Inc. What is CVI? (2004). Retrieved from
http://www.aph.org/cvi/define.html
Cohen-Maitre, S. A., & Haerich, P. (2005). Visual attention to movement and color in children
with cortical visual impairment. Journal of Visual Impairment and Blindness. 99(7), 389
- 402.
Creech, J., & Golden, J. A. (2009). Increasing Braille practice and reading comprehension in a
student with visual impairment and moderate mental retardation: an initial study and
follow-up. Journal of Developmental& Physical Disabilities, 2, 225-233. doi:
10.1007/s10882-009-9137-9
DAurizio, V.D., (2011). I-M-ABLE: a pathway to literacy. Journal of Visual Impairment &
Blindness. 105(3), 141-144.
Erickson, K.A., Hatton, D., Roy, V., Fox, D., & Renae D. (2007). Literacy in early intervention
for children with visual impairments: Insights from individual cases. Journal of Visual
Impairment and Blindness. 101(2), 80-95.
Jackel, B., Wilson, M., & Hartman, E. (2010). A survey of parents of children with cortical or
cerebral visual impairment. Journal of Visual Impairment and Blindness. 104(10), 613623.
Leung, B., Yates, M., Duez, P., & Chau, T. (2010). Text entry via character stroke
disambiguation for an adolescent with severe motor impairment and cortical visual
impairment. Assistive Technology. 22: 223-235.
Machalicek, W. (2009). Early steps alphabet Braille reading program improves the ability of
children with visual impairment to read high-frequency words. Evidence-based
Communication Assessment and Intervention. 3(2), 87-91.

HELPING STUDENTS WITH CORTICAL VISUAL IMPAIRMENT

8

Newcomb, S. (2010). The reliability of the CVI range: A functional vision assessment for
children with cortical visual impairment. Journal of Visual Impairment and Blindness.
104(10), 637-647.
Roman-Lantzy, C. A., & Lantzy, A. (2010). Outcomes and opportunities: A study of children
with cortical visual impairment. Journal of Visual Impairment & Blindness. 104(10),
649-653.
Swift, S. H., Davidson, R. C., & Weems, L.J. (2008). Cortical visual impairment in children:
Presentation intervention, and prognosis in educational settings. TEACHING Exceptional
Children Plus. 4(5), 2-14.