Saturday 4 February 2012

Cerebral Visual Impairment CVI - A barrier to learning?

a.    While there may other issues to consider for our purposes it is the vision part of the brain that is damaged.
b.    A fundamental visual barrier to learning is caused by the inability to maintain focused or fixed visual attention.
c.     The issue with selective attention makes it difficult to filter out visual distractions and to make sense of a crowded scene.
d.    We can all relate to this because we all get distracted by incoming sensory input.

Cerebral visual impairment (CVI) is a difficulty seeing and making sense of the world, caused by damage to a part of the brain and not merely the eyes. It is not as easy to diagnose or explain as may be an ocular impairment. On the other hand there may be more improved vision over the years than might be expected with an ocular impairment.  CVI  can affect a child in some quite specific ways, in particular in relation to the brain’s attention system. The good news is that you can often dramatically modify the environment to enhance the child’s attention. The right environment encourages a child’s selective attention and in turn encourages the development of concept formation. Concepts formed in early childhood almost always are dependent on a child’s ability to maintain attention for a period of time. And by that I am chiefly referring to visual attention.  Whether it is the understanding of cause and effect or distinguishing similarities and differences or the ability to make choices, all are rooted in the ability to maintain and sustain focused visual attention. 

First you have to ask the right questions. With cerebral visual impairment (CVI) the question you want to ask concerning your child is what is stopping them learning? What is the ‘barrier to their learning’? What is causing them not to progress? It is the answer to this question, which is the core issue for the child. If you are not addressing the core issue then you will be off the mark in your solution. What I am saying is that your child with visual impairment due to brain damage has a fundamental problem with giving and keeping visual attention. To recognise that your child’s dominant problem is a difficulty with giving focused attention is the first step towards meeting their needs. The difficulty is not first and foremost a motor skill delay. It is not even primarily poor visual acuity (of course this may be part of it). It is not chiefly coordination. 

I am not by any means understating the significance of any of these in a child’s learning and development. But many people think of all kinds of things when they try to understand the child with CVI and the answers they come up with may well be good answers but they are secondary issues. The central and fundamental difficulty that your child faces is an inability to give and sustain visual attention. For example it is difficult for them to make sense of a crowded picture, or to pick out someone familiar in a crowd, or to see a favourite toy if it is surrounded by other toys or to pick out their sock from a basket of clothes. All these examples come down to the same thing. This is not rocket science but it does need to be fully appreciated. If you do not have the child’s focused attention at the point of learning your efforts will be wasted. The child’s mind will be elsewhere; their eyes will be looking elsewhere. Unless you have the child’s attention and they are focused solely on you or on the object or the task and they are not distracted by noises or clutter in the room, you may be wasting your time and the child’s time. 

You only have to look at your own experience to confirm its truth. Your mind wanders during a driving lesson so you don’t hear the instructor and you miss the key instructions or information. When it is a matter of a child and their learning they cannot afford to miss out on vital visual information. The situation is acute with a CVI child because of their severe difficulty in giving focused attention. It is clear that people have problems concentrating when there are competing sounds or sights. On the London Underground it is impossible to read when you are being bombarded by public announcements over the airwaves. People cannot parallel process. It is extremely difficult to listen to two people at once. When you see that you realise what the CVI child goes through. For it is one hundred times more difficult in their case.  For children with brain damage the problem is magnified a 100 times. They cannot see what is staring them in the face. So we need to look at ways of helping them to focus their attention. You will have to find ways of capturing and maintaining your children’s attention, enabling them to see and not to miss the obvious in their field of vision and you must do it in a way that matches their speed of thinking and their speed of analysing visual information. You must try to see the world as they see it. Once you do that the whole matter is logical and you will even begin to think up your own ideas and strategies for enhancing your child’s visual attention.

The above  article is the opening chapter of my handbook for teachers, called ‘What can I do for my CVI child.’ - Maurice

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