Thursday 9 December 2010


FOR CVI CHILDREN THE KEY is to enhance their skills of attention. To do this you can:

Visually simplify what you present or choose toys that are visually simple.

Make sure elements of the visual target are in sharp contrast to each other (bright colours are best) with no important small details (like little eyes on a teddy).

As often as not a CVI child spends a lot of time in a room which has patterned wall paper, lots of pretty pictures of family members on the walls, shelving with displays and ‘niknaks, and light coming in from both windows and ceiling. In addition toys are frequently spread around the room in no particular order (especially if he is not the only child). In other words to put it bluntly, to him at least, he is living in chaos. We all know how unpleasant it can be to live in a messy house / room. For a CVI child it is more than unpleasant it is disabling. It prevents him from seeing and making sense of his world properly. And in turn it hinders his learning and development.

So what can you do about this? There are certain solutions I have recommended and seen some very enterprising, resourceful dads develop.

(1) Clear the room space where he is directly playing. Move furniture away so things are not too close to him. The further things are away the less he may see them (especially if he is near sighted) and therefore the less they are a distraction. A blurry background is actually a help to a child who finds the complicated world just outside of his reach a little too overwhelming. A nice trick (suggested by Professor Gordon Dutton) for children in a PMLD school is to have around a few pairs of reading specs (+1.5 or +2).This has the same effect: it blurrs the background and makes the world a much simpler place because he can only see clearly what is nearby!

(2) If you really can’t clear the space then you may be able to create a ‘little box’. I think the idea originated with Lillie Nielsen in Denmark. You can buy a ready-made foldable room/box good if your child is not too old. One company makes something called a 'BeActive Box'. I have used this and it is quite suitable for little ones. There was also a product patented by this website: It was a foldable screen that you could use as a plain background. But you can get any handyman to knock up a simple screen with 2 or 3 sides. Paint it in one plain colour and put it around your child while he is playing.

(3) Lillie Nielsen developed something else she called a resonance board. But if you don’t want the expense of buying this (and these things are expensive), you can make it yourself with a square metre of board and a 2-inch ridge around the edges. One resourceful parent put pipe-insulating foam sleeving around the edges for safety. This creates a useful plain play area that stands out from everything else.  It also contains whatever toy you want to put in there so it does not roll out. But a word of advice. Again one thing at a time. If you place two and three toys on the board your child will struggle to see any of them. Much better to put only one toy. Then he can easily see it and reach out for it.

Wednesday 8 December 2010


OK LET'S THINK of some ways of helping your child to make the best use of his vision. Suppose your child with CVI (we’ll shorten it to CVI - cerebral visual impairment is a mouthful) has a problem with scenarios like the following:

He does not seem to see or to notice something when it is surrounded by a crowd or an array of other toys;

Compared to other children he takes a long time to take everything in and make any sort of response;

He appears to take longer to focus his eyes on a toy you put in front of him;

On top of all this he does not even seem to look at toys in front of him. He feels his way when you know he can see (?). Or he looks and then he turns his head away and then he reaches out and grabs the toy while looking away. It is as if he cannot use his hands in combination with his eyes. And that is probably close to the truth.



That means:      
Present one thing, one toy, one picture at a time. NEVER SHOW HIM TWO TOYS AT ONCE. That will only confuse him. He is not ready to make a choice just yet.

Introduce each object slowly:

Do not lose your patience – you will need all the patience you have got – and a lot more.

Give him plenty of time to explore and examine objects. DONT RUSH HIM.

Work with one activity at a time. Don’t rush on to another just because you think he’s bored.

Keep to one sensory input at a time. Vision, hearing, touch but not all at once!

On the other hand sometimes you can gradually add the sense of touch to help him see.

Show him pictures and visual images in isolation without a background and strongly outlined.

Avoid figure-ground clutter.

Come on you guys - let's have your comments and contributions.I know you are out there... What do you think of the blog? Does it have potential?

Sunday 5 December 2010

The Eyes work with the Brain

The Seeing Brain 
When people think about vision or the sense of sight what do they immediately think of? Eyes! But actually seeing takes place entirely in the brain. What the eyes do is take the electrical signals entering through the pupil, which fire the neurons in the back of the retina (a tiny area the size of a postage stamp!), and are sent along the optic nerve to the visual cortex (occipital lobes). But that is only where vision begins. The ‘data’ is sent forward to other parts of the brain and back again like a relay. And thus a moving image is born! This is a rather simple version of what is really a ‘breath-takingly’ complex sequence of events. The point is that seeing occurs in the brain. To prove it just close your eyes and imagine the person you love the most. You are seeing them are you not? Yet your eyes are closed...

Saturday 4 December 2010

Attention and Neglect

Of vital importance is this notion of attention and its opposite, what might be called ‘neglect’. Attention is a key aspect to a child’s learning and to his proper functioning in the visual world. The ability to give full attention is essential in all areas of daily life, whether it be social relationships, academic learning or even play and exploration. Teachers can tell if a child is receiving information by the child’s body language. The movements of the eyes especially give away so much about a child’s focus of attention. Wandering eyes suggest a wandering attention; still eyes looking forward on a target indicate a focused attention. A child with CVI does not generally have typical eye movements and from this fact alone it can be inferred that their attentional system is not functioning properly.
Attention and neglect are tied up with the brain's ability to integrate sensory information and handle several sensory inputs at once. A typical child with CVI does not have the ability to handle multiple streams of information simultaneously. They will typically attend to one thing/input and neglect the others. Put another way they do not dual process: they are unable to handle sensory inputs from more than one sense at a time. It is not in point of fact easy for humans to dual-process. There comes a point for all of us when there is a ‘sensory overload’ if the environment is too noisy and there are multitudes of people milling around and numerous activities taking place at one and the same time. Developmentally it is only around four and a half years of age that a child starts to be able to ‘dual-process’. As a child develops their ability to handle more than one source of information at once gradually increases. I suspect that the attentional system learns to switch focus between different inputs so quickly that it is almost like a simultaneous processing, rather like learning to drive a car. When a person first takes driving lessons each action or sequence is carefully enacted as a separate motion. But after a period of time the sequences are integrated and performed almost as one complete action. The same thing applies to playing an instrument such as the piano or the guitar. Your body has the ability to learn sequences of actions and embed them in the memory so that such actions and sequences become ‘automatic’. When experiencing two or three individual sensory inputs at once the same principle should also apply. Receiving sensory information must be essentially sorted in a sequential manner but by learning, the sequences become embedded through familiarity and repetition and knitted or integrated together. Thus listening to and looking at an adult can be performed at once and the information integrated by the parietal lobes and other parts of the brain concerned.
What is the implication of this for parents, teachers and therapists? It means that a child with CVI will experience severe difficulties when presented with a complex pattern or scene, either in a book, or in a room. They will find it difficult to distinguish toys on their tray if presented together and at once. Choosing will be difficult as it demands the skill of being able to see and distinguish between several objects. Focusing on a task will be demanding in an environment which is busy with numerous sounds and images. A television on in the background or interruptions such as a door opening or sudden noises will place heavier demands on the attention of a child with CVI.
Those working with the CVI child will therefore need to think carefully about the environment, about the number of and nature of toys the child is given. Modifications to the child’s immediate environment will not be wasted and will help the child to keep his attention on the task at hand.

Please feel free to post your comments and agree or disagree with me or share your experiences. This will benefit others.