What is cortical/cerebral visual impairment(CVI)?

• The eyes work well, but the area of ​​the brain that analyzes vision does not understand the messages sent by the eyes.
• The brain does not understand or interpret what the eye sees.
• One of the main factors affecting vision defects in children.
• Low vision strongly affects children’s gross and fine motor skills.

 

Causes cortical/cortical vision to exist

• Meningitis
• Hydrocephalus- excessive accumulation of cerebrum in the brain
• Lack of oxygen to the brain at birth
• Bleeding into the brain in premature babies
• Structural abnormalities of the brain.
• Medicines/toxic chemicals
• Drowning, convulsions
• Metabolic and health-degenerative diseases

 

CVI characteristics

1. Color preference
2. Need for movement
3. Visual latency
4. Visual field preferences
5. visual complexity
6. Light-gazing & non-purposeful gaze
7. Decreased distance viewing
8. Atypical visual reflexes
9. Difficulty in visual novelty
10. visually guided reach

 

 

1. Preference for certain colors

• Red color -55 % Yellow color -34 % Other colors -11 %

 

2. Attraction to movement

• Looks intently at moving objects. Eg: fan, moving vehicles
• It looks like it is moving because of the reflection from shiny objects

 

3. Delay in aiming at something

• When an object is placed in front of the child, it takes time to show a visual response to seeing it
• This can vary depending on the color, movement, complexity of the objects
• It is important to give the child as much time as he needs to respond

 

4. Being from discretionary field of view

• This can be seen in every child (with CVI).
• Many children prefer peripheral visual fields.
• Therefore, they do not see the subtle features of the object and only see the basic shapes
• Sees moving objects more in low light conditions

5. Visual and environmental complexity visual complexity

• The complexity of the toy is difficult.
• Visual background complexity
• Obstacles in the external environment – ​​response is greater in a calm, quiet, less disturbed environment

 

6. Light-gazing & non-purposeful gaze

• Turns head towards bright lights
• Looking at objects that emit light

 

7. Difficult distance viewing

• Stares at toys or faces

 

8. Atypical visual reflexes

• Does not blink when a finger is tapped on the nose and a hand is moved in front of the face

 

9. Difficulty in visual novelty

• Difficulty recognizing new faces/toys other than familiar faces or toys
• Try to avoid new things

 

10. No one looks at something and then reaches for it. Decreased visually guided reach

• Looking at something and reaching out do not go together
• Looks at the object, turns away, and reaches for the object
• Otherwise the first mouth grasps the object, and the second turns towards it

 

Ways we can intervene in different stages of cortical/cerebral vision loss

 Phase 1

Objective: To encourage awareness of visual stimuli.

 When communicating with the child, wear a bright  ribbon and speak gently while looking into the child’s eyes.

 Hang bright colored objects on a string above the crib.

 Shine a dimmed flashlight near the child’s face to encourage them to focus on the light.

 Use black backgrounds to reduce visual complexity

 Place the child in a simple, non-distracting room with a bright simple toy.

 Show the child simple toys with bright colors of red or yellow.

 Hold a bright toy in front of the child’s eyes and encourage the child to look at it and reach out to hold it.

 Sound and Light Combination: Use a small flashlight and place it next to a musical toy to combine sound and light.

 Sing with bright accessories and movements: Wear a bright bracelet or necklace and sing to the baby while moving your hands near their face.

 Colorful mobile toys: To attract the child’s attention

 

Phase II

Purpose: To increase visual attention and connection with objects.

 

 Tracking with toys: Move a bright toy (like a yellow ball) slowly from side to side, encouraging the child to follow it with their eyes.

 Mirror game: Place the child in front of a mirror and let them observe their reflection, or place bright stickers on the mirror to get them to focus.

 Finger paint: Use non-toxic finger paint on a surface such as a black or white mat.

 Toy Movement: Gently roll a colorful ball to encourage eye tracking and hand-eye coordination.

 Simple Puzzles: Use large, simple, tall puzzle pieces (such as black and white shapes) to help the child recognize and focus.

 Introduction of simple two-dimensional images gradually showing three-dimensional images using cards and real objects.

 Naturally colored foods: Eat brightly colored foods (such as red, yellow or green) at meal times eg carrots, greens, beets.

 Use contrasting objects, such as a dark bowl against a plain tablecloth, when eating.

 Place colorful floating toys in the bathroom to attract attention while bathing.

 Adaptation to daily tasks; Getting used to picking up and combing the hair using a comb with a shiny leaf

 

Phase III

 Objective: To improve the ability to explore and interact with objects.

 Provide toys with buttons that light up when pressed. This encourages both tactile and visual exploration.

 Offer a brightly colored shape sorter to improve hand-eye coordination while helping the child identify different shapes.

 Read a book with big, bold pictures in bright colors (like red or blue) and turn the pages slowly for the child to follow.

 Encouraging the child to build using large, brightly colored building blocks

 Blow soap bubbles, have the child follow their movement and try to catch them.

 Kitchen Activities: Give the child brightly colored plastic kitchen utensils like spoons or bowls to play with while you cook.

 Encourage the child to hide colorful toys around the house or in a sandbox and find them.

 Helping to identify changes, boundaries, in the environment.– eg; Descents, slopes, changes in surface

 Go outside and look for colorful objects like flowers or birds in the environment and point them out to the child.

 

At home and at school, other methods should be used to address the child’s remaining CVI symptoms

• Let the child describe what he sees
• Hidden image search
• Finding differences in images
• Finding parts of a complex image
• Look for visual cues in the environment
• Difficulty writing letters is common so light boards can be used.

 

The vision of children with cortical/cerebral Visual Impairment  can be significantly improved. Changes in simple environmental tasks at home and school can make a difference in their performance.