How do  I know if my Child or a Pupil in my class is VIsion Impaired?

Some behaviours when occurring together 

can flag up a problem that is to do with vision. 

1. Close viewing - peering close to read
2. Head turning - turning at an awkward angle to look
3. Habitual clumsiness
4. Consistent off-task behaviour - misbehaviour can  be caused by lack of clear sight
5. Exceptionally poor spelling despite being an able reader
6. Regular careless miscuing of known words - reading words incorrectly 
7. Underachievement - especially when you  know  he/she is more able
8. Screwing up eyes in light
9. Consistent copying from a neighbour
10. Eyes that look crooked or misaligned like a squint
11. Eyes that look red or watery 
12. Eyes that move eccentrically - turn in or out
13. Difficulty looking directly at your face or eyes - this can be related to nystagmus
14. Lack of confidence in an unfamiliar environment like a new school or supermarket
15. Distress in a noisy, busy environment 
16. Covering one eye to look 
17. Turning head rather than moving eyes to follow a target

If you do think they have a problem seeing at all get their eyes checked by an optician or at A&E in an eye hospital. 

Neuroplasticity and Special Needs

An important area of research underlying work with children and young people with an injury to the brain is neuroplasticity. 50 years ago the brain was believed to be permanently hard-wired and unchangeable. Once it was fully developed nothing that could be done to change it. That had implications for children with learning difficulties. However research by neuropsychologists such as Aleksandr Luria and Mark Rosenzweig and psychiatrists like Norman Doidge has shown that old view of the brain is wrong. Neuroplasticity means that the brain can be rewired at any time of life. This must give hope to parents of children with learning difficulties, not to mention an adult who has a stroke.

The Russian psychologist, Luria was the founder of neuropsychology. He combined psychoanalysis with neurology. His book 'The Man with a Shattered World' is about Lyova Azetsky, a soldier with a shrapnel wound to the brain. He writes "Great damage to the left side deep inside the brain - in a coma then awake – had very odd symptoms..." Shrapnel was lodged in the part that helps us understand the relationship between symbols.  He could not understand cause and effect, logic, or spatial relationships. He couldn’t tell his right from his left. He didn’t understand in, out, before, after, with.  So he couldn’t understand a whole word or sentence because all those things involve relating symbols. Luria however had no treatment for Azetsky. Luria worked before the advent of MRIs but he mapped out the functions of areas of the brain through his extensive work with adults with specific brain damage. By observing the symptoms of certain wounds to the brain he concluded which areas are responsible for what functions. 

The breakthrough came in the 1960s when Mark Rosenzweig, a pioneer in brain plasticity, conducted experiments on rats in the laboratory. Rosenzweig’s studies of laboratory rats at UC Berkeley in the 1950s and '60s, showed that "environmental therapy" can stimulate brain growth. Rats living in an "enriched environment" with stimulating interactive tasks performed better at learning activities than those in passive, impoverished conditions. Rosenzweig’s work was thorough and was groundbreaking. Hw wrote, "We did not invent the concept of the 'enriched environment,' but I believe that our publications introduced the concept and the term to the neuroscience community." In 1982, he was officially recognized for demonstrating that the weight, chemistry and structure of the brain are affected by environmental stimulation. 

In ‘The Brain that Changes Itself’ (2007), Norman Doidge, the Canadian psychiatrist describes the case of Barbara Arrowsmith Young, who had notable strengths, such as a remarkable auditory and visual memory and highly developed frontal lobes. But she had significant learning difficulties. She read Luria’s account of Azetsky and recognised all her symptoms in that soldier. In particular though she could easily memorize things she could not understand spatial relationships, which meant among other things she was unable to read and unable to tell the time. She saw everything in fragments. Azetsky had shrapnel lodged deep in the left temporal lobe. Luria located Azetsky’s brain injury to the intersection of the temporal occipital and parietal lobe. This is the point where visual images, spatial relationships and sound/language are all integrated. It is the juncture where perceptual information is associated. Because this area of the brain was damaged the subject could not relate his perceptions or parts to the whole. He could not relate symbols to one another.  This gave Barbara an understanding of what was wrong with her. But the answer came when she read the work of Rosenzweig. His work with rats established beyond doubt that extra stimulation helps to modify and enlarge the brain. If a brain can be modified and changed then by enriching the environment and providing the right kind of stimulation and intervention the weaknesses in her brain can be improved. Barbara worked out a scheme of exercises and worked on them intensely over a period of many weeks. The result was that she actually improved her ability in all areas. She could now tell the time. She understood what people said in real time. She grasped logic, maths, grammar and reading. 

Barbara was so successful that she started a school where the focus was on brain exercises. Examples of those exercises are tracing complex lines to stimulate neurons and memorizing poems by rote. Ironically in the 19^th and 20^th century educators advocated practices, which Barbara introduced extensively in her school.  At one time classical education involved learning by heart long poems and recommended attention to precise handwriting and elocution. These practices now dropped from educational programmes are acknowledged to be good for stimulating neurons and increasing the size of the brain. 

Minimalism and the CVI Child

This was first published on the CVI Scotland website. Here's the link - https://tinyurl.com/bdzfr4z3 

I'm an advocate of minimalism when it comes to children's learning. The word first appeared in 1913 in a painting of a simple black square on white by Kasimir Malevich. His art was innovative and contrasted starkly with the lavish, decorative styles of the past and it paved the way for the 20th century minimalist movement. In sculpture and painting, large, bold and simple shapes replaced elaborate intricate designs. In music, it was characterized by repetitive short phrases and in writing brief, snappy statements replaced decorative, flowing language.

Recent research shows that minimalism applied to education can have a dramatic effect on children's attention and learning. Highly decorated walls are distracting and can obstruct learning; a classroom stripped to its bare essentials can offer a calming, focused learning environment. Removing what is superfluous enables what is important to stand out; there is an unambiguous focal point and it can be a calming influence. The trouble is there are conflicting needs in classrooms, such as the placement of resources, workbooks, equipment, displaying and celebrating children's work to demonstrate outcomes or the illustrating of key words and concepts. Again, many of us teachers are incurable hoarders and our lives, our workplace and our homes are full of clutter. It is the world we live in and are used to. It takes an effort to change habits of a lifetime. But many people are finding that decluttering is liberating and helps them create a fresh start, like spring cleaning.

What of CVI children in the special school? They are the ones who will most benefit from a minimalist approach. But here there are even more challenges because of heavy equipment, hoists, beds, wheelchairs, objects of reference, all that necessarily goes with the child. Are these children progressing as well as they could? Or is their world just too full and too cluttered? Are they able to see the wood for the trees?

How can we create the optimum environment for the child with CVI? In a sense it depends on the child and their visual condition. Damage to the visual pathways can affect a child in different ways. Damage to the ventral stream can affect recognition of objects, people, and places. But if the dorsal stream is damaged it can impact spatial awareness, finding things, moving about and the attention system. The ventral stream and dorsal stream are terms for the directions of flow of information in the brain. Starting from the visual cortex at the back certain forms of visual data are transferred to the temporal lobes, which form a sort of library or storage system for names, objects, faces and places in the brain. This is the ventral stream meaning 'underside'. The other route is up to the parietal lobes, where incoming sensory data are brought together where spatial processing takes place without our knowing. This is the dorsal stream, meaning 'upper side or back'. I am told that more children have dorsal stream damage so it makes sense to focus on a problem many of these children have that affects making sense of their busy world, seeing in an overcrowded environment and moving about in space. They cannot make sense of what they see because there is too much visually to take in, too much to understand, and the pace of constantly changing scenes is too fast for their brains to keep up with.

Toys strewn over the floor create clutter. A child can only play with one toy at a time. Why have more than one on show? The only reason I can think of is you may be giving your child options or encouraging choosing. In which case let the child choose and put the other one away. A CVI child may well not see multiple toys in a box, they may only be able to see one thing. In the nursery one activity I often observe is emptying the box of Lego and construction toys out onto the carpet. Our CVI child is likely to find this overwhelming so why not have an area just for him where he can take out of a box or bag one toy or Lego brick at a time. I vividly recall a scene in mum's front room where the little boy sat on the floor with three toys placed in front of him. He stared blankly. Mum took away one leaving two and he continued to stare blankly. Mum took away another leaving only one toy and he immediately looked and reached out for the toy. That was either a major coincidence or a dramatic demonstration of the power of minimalism, the 'power of one'. Put only one toy in front of the child and he can make sense of it. 'Less is more'.

If you cannot strip the room to bare essentials try keeping at least the front wall and teaching area clear. Avoid sticking cards or labels to the outside of the interactive whiteboard. Try switching off the front light and dimming the lights. Space each display item so there is a spacious gap between each one. Make displays large and contrasting. Keep the workspace clear. For focused work have a dedicated corner or cupboard that is plain and uncluttered. Look into the literature about creating a 'tent' by Suzanne Little or 'box' by Lilli Nielsen. Storage of toys should be neat and perhaps covered by a 'curtain'. Each object of reference should have its own 'box' in a cabinet and this can also be covered by a curtain.

Minimalism for the CVI child means creating a world where only one thing is allowed to be the focus of attention all the time. Make that one thing pop out so it is obvious by using bold contrast, large details and recognisable shapes. By following the example of Malevich's radical black square on white we can make the world of some of our CVI children a more meaningful place.

 Simulating the way she sees

Over the years I have done numerous training sessions in venues such as schools and more recently online, on the topic of supporting the child with impaired vision with a whole range of professionals and parents and carers. One essential part of the training is always using the so-called sim-specs. It is possible to give anyone a rough idea of what it is like to have, for instance, a restricted field of vision (sometimes called ‘tunnel vision’) by putting on a pair of sim-specs. Then wearing these as the person tries out the activities and tries to walk around they have a sort of idea what it is like for the child. It is far more difficult to ‘simulate’ an impairment of vision caused by different areas of the brain rather than the eye itself. We are of course talking about cerebral visual impairment or as it is sometimes called cortical visual impairment. 

Simulate This

If only I could make you see

How even half my world appears to me

If I could only just describe

Precisely how my eyes

Send signals to my brain

Then it would be plain 

How different my world is from yours.

You see, the problem’s not my eyes,

It’s the axons and the cells

The connecting bits inside

I may seem to have good sight

But deep within my skull,

Buried in this shell

Is a mesh of lanes and lines

And there’s something not quite right

In the tangled strands of white

The stuff that’s wrapped in myelin

Try smearing Vaseline

On the centre of your specs

Now roll up a newspaper

And notice the effect

As you peer through the hole

What you see is imperfect

It’s a narrow, murky world

Now try looking through one eye

And cover up one side

Can you now understand

What it’s like to be a person

With a sight impaired condition

And that’s less than half my world

And it’s still not what I see

Try blinking slowly,

So half the world is dark

And the other half is light

I’ll tell you what it’s like

Your sight becomes disjointed,

Your vision interrupted,

Things appear and disappear

You’re missing half the world

So of course, you’re in a whirl

Wear sun glasses indoors

And switch the house lights off

Watch how the room becomes

Confusing and obscure

Note how it makes you feel

Afraid and insecure

And that’s still less than half my world

And it’s still not what I see

Try out the sim specs, 

Tunnel vision, and RP

Hemianopia and myopia 

What exactly do you see?

You see something that resembles 

What’s happening to me

But it’s still less than half my world

And it’s still not what I see

It’s hard to grasp I know; 

It’s still a mystery

I cannot see like you

And you cannot see like me

All I ask for please, is

A bowl of empathy

Just try to see the world

As it is to me.

© MJ Sparrow 2022

I thought I would try a different approach today. I tried to get inside the head of a young person with VI or  one of the many kinds of CVI - cerebral  vision impairments. So here goes & do please let me know what you think - by email: visionimpairedchildren@gmail.com - I have more poems to come. 

Please Understand

They asked me what I could see 

They inferred that I was blind

I said look you’ve really got it wrong 

I didn’t mean to be unkind

It’s like a missing part 

That fell out of my head 

They laughed at me as if I joked 

Or misheard what I said

How can I explain to you 

The air that I inhale

Or the force that pins me down 

When I’m blasted by a gale

So how then can you comprehend 

The different way I see

I wished that I could tell them 

Exactly what I mean

Or even better show them

By projecting on a screen 

Then perhaps they’ll understand

And not treat me like I’m three

© MJ Sparrow 2022