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Assessment & Instruction Considerations for Students with Cortical Visual Impairment

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Presented by Suzanne Dinwiddie (TN D-B Project) and Lee Ellen Whitefield (Murfreesboro City Schools) on 2/10/2023 TN VIVA 2022-2023 Session Description:

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all right well happy Friday and welcome everybody to today's Tennessee Viva on professional learning session and we're really excited or first day to be talking about cortical visual impairment and again our specific title for today's session is assessment and instruction considerations for students with cortical visual impairment we are we are so fortunate to have really experienced should I say award decorated Vision professionals here with us today including Whitefield news with Murfreesboro City School Anna Suzanne's in Woody currently with the Tennessee deaf blind project I just want to say that a special shout-out for Suzanne Suzanne recently was recognized by the Council of exceptional children division on a visual impairment and blindness or the exemplary Advocate Ward which is small feet and if you know Suzanne or get to know her you will realize just leave the breadth of her career the impact he has had here in our state and in so we are we are so fortunate to have you still with us still meaningful he's just doing such great work and so excited to have to hear some van Lyon as well for sure and so thank you all for being here where the session is going to be here warning for those who cannot attend live and so just know that we will have this available soon online for those two to watch as well and another side note before we do get go I just a reminder that the Tennessee Viva visual impairments Virtual Academy is an ongoing learning series that is a collaboration of the Tennessee School for the Blind in the universe visual disabilities program and the Vanderbilt Kennedy Center and so these are ongoing opportunities to grow as professionals is there are topics that you feel like would help you grow as professor do not hesitate to let us know what those topics are so that we can go in and find the best of the best to bring him in and speak to you I hope you succeed here in Ark so without further Ado I'm going to step back and let these wonderful ladies take this away and alright let's see how this is working that's not even the first let me go back to the beginning that will tell us something here we go everybody see the screen yes yes but the share screen panel is blocking the very top of your image I think isn't it if you are will appreciate that Lee Ellen and I have struggled mightily with our the technology portion hold on I'm not finished yet I can change this time travel okay it is supposed to tell me what's today or we go let's how's that not still under it and it'll go away in a minute it's when I'm get discount on happening. It has been awake I'm glad to be here Lee and I are Leah Lynn and I have worked together for a long time and we love going down different rabbit holes of subjects cerebrum cortical visual impairments has been one that we've enjoyed brain into we attended with an interesting Workshop in South Carolina in December with Guardian all day you can never changing the subject of cortical visual impairment in the assessment the definition of it and love this picture to start off with because it just describes at all what I bring has to do see talk understand last field and we when we talked about CBI we realized the brain spends 80% of its time processing that since since her and firm so I'm a presentation is going to talk about assessments and strategies that is also focusing on the new voices and idea surfacing in the field and in out we assume all participants have a working knowledge of a brain de stijl impairment and ready to rethink maybe some strategies that you've been using and it starts with and I apologize because that still blocking my screen is so much in the in the field is changing we not attempting to give you all the updates but showing you where to find and there's this little chef making chain do and he said oops I forgot the purpose the purpose of this change in the CBI world is to stop thinking what a child or students and start thinking how they say we're going to take a quick preview of the what we know about CBI and their pathway I'm going to pull up I'm Christine Roman Reign skate and she can be in Gordon Denton is in blue and a newcomer Rachel peeling Suzanne krayn on what their theories are and how they work with that because the visual Pathway to Pathways that can how to create an action plan for the body it enables the brain and body to stay connected so we can travel safely through the environment and inform our executive functioning and takes a dorsal stripe in The ventricle strain and they connect several places that's not done in isolation isolation is done in unison with each other so it's real quick look at the dorsal stream the where of it all the chimp of love peripheral vision Roman really know this part its Phase 1 and Phase 2 and we're so familiar with CBI in that and it requires movement lights color we have to watch the visual field it guides our actions but it's a slow Miculek UT and low detail when Dudley and blue talks about depression field and you really said it functions on the subconscious level in the moment and I would really like that because he's saying the information that is gathered is not gathered efficiently and ends up in what I call the junk drawer of information it is not categorized or it can be easily retrievable because it's information is not easily retrievable we need to still work with 3D and touch and not really introduced that 2D pictures so helpful and navigation but it doesn't store the route pilling's talks about how Vision when it's just the dorsal strain can help you locate places in space you can't learn motor skills by visually observing them touch is important for Learning and the peripheral input that you're getting is a low-quality the inability is some kids even turn off their peripheral vision so in that case when we're working with kids that are really heavily in phase one face to the dorsal strain I need to remember touches of important learning tool we need concrete object not to do we need very structured environment we need to realize that any change in people Pace objects will create a latency and they're also be a disconnect with brain and body so movement will not be as coordinated then we go over to that Circle the what the temporal lobe That central vision that we all know Roman disguise it as phase two and three the projects are visually record can identify objects we can use details seeing a ray of objects and a different distance Jack says functions on a conscious level well so you can match items from existing experiences and build a library you get more visual guided reach with the upper and lower lands and the other really big Courtney information is at the information to Auditorium the internet in visual information is stored in a in a more fine account which I have written up there so it's more organized it can be categorized sorted discriminate and retrieved to be able to communicate and use faster killing says some children who are using the ventricles are turning off their peripheral so we need to be careful fat and they're missing the whole picture I like it grew car and this is where complexed it gets to be an issue and both dorsal and ventral car LED Alan and I are both orientation Mobility instructors Mind Body disconnect is real and it needs structured environment extras external supports and landmarks a safe movement she's answering Pittman into a player if you go into the zoom meeting and click more in meetings and trolls for meeting controls more desktop an option to hide floating meeting controls okay so I get out of the show and their stay stay where you're at and I don't have quite the same more I see more and it says select is there a chopper hi loading dock you I wonder what else I can learn but from you from cuz I had to my videos so back to what we were talking about in the change in the CBI world when we went to this city I Symposium Ellen names Dale and Chris Russell helping us a present information and the most fascinating part is they talk about the great meetings of all the CBI mine from Denmark and Sweden and Switzerland in UK and America and they all met at Perkins because Perkins is trying to develop a different CBI protocol to see if they could come to a consensus on what everybody agrees upon on this ever-changing area of learning and it's full of strong will Professionals in this is the word of Ellen Manziel what everybody even cared for each other you can imagine trying to get Christine Roman laugh and Gordon Dutton name two other people to sit down and come to a common consensus so they talked about what they're experiencing what tools they used and what the researchers were saying I'm using on your left you see all these different inventories and screenings we have a link that's coming for each one of these were you can access these assessments here is what well that's not good you they just get really big okay that scared me for men here is what the consensus that came up and that they are new on CBI and it actually starts with the name they realize CBI is such a well-known term they did not want to change Tucker to bring bass fish on parents but they put cerebral cortical visual impairment so you may see CBI or you may see it written out with both because it's a broadening that Stephen here is some other promising practices that they agreed on to be Isaac Spectrum it ranges in severity there's no such thing as mild cbro all children receive a should be considered a Acura problems common with stevia CDI stomach more than just Vision movement and auditory information is also affected so they play focus on the whole child children of all ages and regardless of complexity deserve Vision Services as we are getting shortage of vision sometimes we put higher values on where we think we can get our quickest return and we need to recognize the importance of all children of all abilities to get the services they need assessments will indeed be grounded and CBI principles and ongoing it's hard to do just a snapshot because it drives the strategies and instruction the majority of the Sith assessors are using spaces in there four phases not three they're using they've divided phase two into two parts and they're not using the ranges you can do that this is a consensus of what the majority of the people learning media assessment is fluid we need to not think of a child as a basically visual learner or auditory learner we need to know it depends on who where how and why of a task and what sensory system is dominant during the activity really drives your strategies routines in your schedule they really pray visual recognition and not just visual awareness they're using the term visual field preferences and not visual field losses because not all visual feels are restricted because of medical reasons and we're not going to focus on CBI goals for our IP were using them to form and drive the instruction adaptation and accommodations let's talk a little bit about visual recognition of a visual awareness they're really saying that recognition auditory visual is a and we need to know what a child needs to do to understand and recognize that until what we're looking for doing the child uses the just depress your field and we've seen these kids not being stored to be used as efficiently so we're looking for that good central vision and really be able to sustain that gay if is there going to be a visual Learners also looking to see if I can ship games between two different because that's a real indication that exist in 3D mapping the location of items object permanence and extends the learning distance and help dissect that open space that's so difficult kids need to understand what it's saying and that really requires touch innate recognition requires previous auditory and visual experience with the Ottomans items around or the share the same saying features to understand and by stating it I mean the most dumbest features on that item that helps a child quickly recognize it and then that filing cabinet that visual auditory library that we're helping the child develop by using the same pictures familiar pictures and routine so it can be stored in Yonder I love this little video on their stomachs to unpack here this child I came to see was actually released them OT Services because of behavior and lack of progress because the child always rocked we know that a movement is an issue on a child in the lower phases that if an object's not rocking or moving the child might so this is the 32 second video good it a visual attention awareness to visual recognition classic CDI child needed lights color I need to start on this child's left peripheral field. 20 in away and a nose level just real typical that and gone then let's see if this works we see the child looking watch that 16 seconds in in that beautiful you can see it in a minute that's the difference between record sizing and just being aware of it it finally came in an area with his child could see it now she's going to give us a great shift of gaze social smile asthma we get out of her preferred range she's rocking to find it she's continuing to look when it comes back closer to me line there it is and the other really important feature to get from this list eyes are not being coordinated and we need to get her she's seeing her using one eye and she still really passive but you don't see her reaching knowing that that visual guided reach that would say I can be an active participant and not just recognize it but you work with her get my hands on it and not giving you this background that you know they're talking about the need to reassess the current definition for visual impairment and blindness and these are active links to any information that we're giving you to show where we the information but currently the definition for visually impaired and blind is based on a shooting in bishan still does not recognize the constellation of issues seeing and bring based on parents and with CBI I know the deficits are in motor function auditory ability cognition sensory processing you can't just look at the vision so we're here and talk about totally different certification having CBI we talked about different specialty talkin about assessing for CBI because it's a medical aspect and the lack of vision teachers so when we give you this information you need to know you're going to be running into all once a people go walking with cortical cerebrum cortical visual impairment I'm going to show you some stats it is startling in summer again I have the sources because it is such powerful information of the association of medical conditions with CBI now the optic nerve and cerebral palsy those procedures are so high I have got a slide on that but we need to know as Vision teachers that kids with City I have ocular conditions also that infants zero to three who have CBI 82% of them have some kind of strabismus or I miss a line that Archie is 46 of percent of them with CB I have referring to beer so we need to keep that in 9 Rachel was talking a little bit about this before we came on about developmental delay learning disability and h d a d h d prevalent of identifying CBI in these learning difficulties is increasing and the more significant the learning issue is the higher correlation with CBI so is it CDI is it part of learning disability is it both but you're going to be seen this a whole lot more 40% of children who has C premature and then we're seeing a different variety of things that our kids have seizure disorder 50% of the kids receiving with seizure disorder also have so we need to look at this and you need to help classroom teachers when they had these complex kids to know whether they have the CBI certification or not there's some strategies here they're going to be helpful and I will say if anybody has any comment Aaliyah and will read them and interrupt me talk about some going to be at the share the same origin is the function in the back the anterior or posterior of The ventricle and dorsal streams it is where CDI lips visual processing difficulties in key criteria for cerebral palsy and swim show up to 70% kids with CPA have covid-19 the other really new information is optic nerve hypoplasia widely associated with hypoxia and hypo cephalic that we talks on the other spring but it's the wiring at the optic nerve and especially the type of Campus that is where you begin starts with a regulation of the motions and how to handle stress keeping body temperature hunger thirst so that is affected if you have optic nerve hypoplasia syndrome of course in a traditional information the corpus callosum is underdeveloped and beds important cuz guess what that Avenue is one of main attractions between The ventricle and the dorsal stream so we need to think about kids with optic nerve hypoplasia and think of some strategies autism they are doing so much with autism and overlap with CBI that it needed to be mentioned and I mention Rachel killing Chan's ophthalmologist United Kingdom that specializes in as3 but we need to know auction some is diagnosed by a cluster of behaviors and medical history just like CBI 25% of kid is he bi or blindness have those autistic tendencies that we read so much about and so there's a lot of the shared behaviors and visual response but they have divided Vision in kids with autism in four different groups that you are going to be very familiar that opthamologist talk about position processors next aware of it the kids that they have difficulty in orientation to have Sloppy body language or mapping skills and they may lack to feel their body kids with ASD can beat Central process or the what trying to only see parts and strictly focusing on the central vision and a lot of these kids are spinning to see behaviors that we see associated with ASD the opthamologist thing may be visual in nature peripheral processors somewhere where they don't get my contact overloaded. ASD also has the Hedge witch face is not preferring Fishel still but trying to block out other extraneous visual information and kids like rap or rock and a single Channel processors that talk about complexity only one thing at a time I laid since been to multiple sources of input they tend to fixate on wipes and maybe look away from people I'm giving you this information as you go into the classrooms because we are seeing this diagnosis attach the kids with vision a lot did you realize what we want to take from this field of vision and how it affects us I'm going to try this at least you're on let me see if this works out just give me a bit. Will somebody tell me if you can see this screen what do you say it's just it's gray again don't bite it okay okay well that makes that easy I'm going to stop sharing oh but they took away my ability to pick up I can I think I can do it too then okay because I took down the the power think that says you can just press the escape button if you want that little band to come back thank you I Googled it I didn't know that off the top of my head some of the new stuff we're getting if anybody has any comments on that before we start and are you getting kids on your caseload with your autism more than anybody call Virginia I'm looking at the name okay I am trying yes I am sorry I was trying to unmute myself and did not do that enjoy seeing familiar faces to always learn so much from you but I mean as you know we do have students in County with an H in wild to hear that you say we try some of those strategies that we know some things I never even thought about interested in that's a whole minute are you okay I'm sorry you're turning note I was just going to wait to is there anybody else who who wants to come in or have a question now now you're responsible for the chat Suzanne okay I got it over here and watching all right so I'm going to get rid of my meeting controls there okay so I wanted to thank Suzanne and Anna for letting me join in and go to the yeah Symposium I learned a ton a ton of of new information so as we move through assessment I just want to say that it's really not that way that were moving away from the old stuff it's just that were adding the things that we know now and we were in a anaphase that we're just trying to mix all of those together but I'm looking forward to going to use some of these promising practices with our kiddos so everything that I have related to assessments is from El maisel who's the director of CBI research and development at Perkins Chris Russell with the New York Department of Education it was also part of the deaf blind project in New York for several years Matt Matt tejan and she works while he have courses at in Perth Perkins and he created the what's the complexity framework that some of you may have seen and we'll talk a little bit more about it if you want to get in a real rabbit hole go ahead and go to CBI now Perkins School for the Blind and CVS for lots of information all right so this is a repeating a little bit but now we're going to start to think about how to apply it and put it into assessment so CBI does not resolve and so is anything that we stay here that were like oh it it doesn't resolve and we used to say resolved I have said resolved so I think we we've all been somewhere and we said these things but now knowing that TV does not resolve is interesting so no mild CV I sorry Maya my little floating thing keeps coming back on okay what we know is there more than 10 areas of visual functioning that can be impacted by CBI so we'll talk about some additional ways that we know that it's now impacted color preference may be any colors color or colors contrast Kennedy is strongly impacted by CBI and when Alan maisel spoke she put a very strong emphasis in the Perkins protocol B coming puts a strong emphasis on Andes mints and appearance of I so we'll get into that additionally one thing that I definitely wanted to include in the assessment process is talking about auditory processing deficits among our are in our kiddos with CDI it is it's prevalent it's it's the CV I of hearing if you will and then once we're done with assessments I think about adaptations we want to think of those only when and where we must Snopes so not all over everywhere but only where we must and then it should be throughout the day not when they're when when a child pulled out for services or in other situations that throughout their day and end in their typical environments as much as part as much as possible one thing that I realized was really impressive was there are a group of people adults children parents and they call themselves tires and so these are adults and children that have built networks and that experts have collected information from and they're putting words to to their experiences and how CBI has impacted so I included Three Links there that go will go straight to the Perkins website but there's no my Tuesday quite a bit in the Perkins trainings and then Tina and then the last think there is a panel of adults who have had to have CDI and so that's really interesting to hear them talk and then there's our link that that didn't work but I know that the grad students saw that a video last night but it is essentially it it it is a woman who is expressing what she didn't see after a stroke and then how our nation has developed and she's under how to use it and and how it just continues to develop all right so assessment and CBI some things that we need to remember is assessment definitely takes time must be ongoing and that's did it the changes in variables like brain development increased visual behaviors demands on Vision but I really enjoyed this step from that Chris Russell gave at the Symposium which was to use the 80/20 rule and 80% of the assessment is collection of information without direct contact even with the student lots of interviews parents medical professionals teachers therapist and many observations and so you want those observations over many settings and times of the day and then about 20% of the assessment will be at the end to fill in any information that you that you may be did not collect through the first 80% and including like the are you with the student and what else say that through the assessment and then of course then into activities that our kiddos do day today these areas of assessment or are overlapping each other they are there impacting each weather like in visual field and flutter and all those things it's it's one thing on top of the other on top of the other and your assessment kids can actually be pretty minimal because you're doing whole lot of your data collection through observations I wanted to mention this because I think it's something that way we can look a little bit more closely at with when were assisting students with CBI and that's it we wanted of course include the are the functional Vision assessment learningmedia assessment but will also wrote want to look really closely at environmental assessment and then of course the expanded Core curriculum I did just mention down here a little bit more about interviews but those observations will want in familiar unfamiliar and also an adapted settings so that we're seeing a child learn and in what we would consider optimal environment for them okay so one of the main points of the Symposium was that LMAO cell talk to us a lot about the details of the Perkins CBI protocol that is still in development so I just wanted to tell you a little bit about that and then about the areas because within the areas are also things that we are the what we know now things that are newer to our field that are incorporated into these assessment areas so all of those areas are based on on current research so if you go on the Perkins website and you see the videos for their 16 areas of assessment and on the 16 areas they will have attached research to support the reasons why those areas are in place so it doesn't only look at at CDI so like CDI functioning but a whole but the whole child so there's other information that you gather other than digital functioning digital and they did that so as they receive current information they will adjust the protocol based on that that research as I said 16 areas and of those areas that will also assess compensatory skills that students might need due to the impact of of CBI and it creates reports is so it will look after you when you complete the protocol it is to generate a report for educational team so Suzanne touchdown visual attention and visual recognition already and I love that video of attention and recognition but we want to remember it's a visual recognition is also that it requires that experience and it also requires the ability to bring forth that memory from those experiences so next I have a a video of a student who has CBI and I did not intend to get this on video so I may have set it up a little bit differently but I just went with it and I wanted you'll see a lot there's a lot going on but I put this after visual recognition going to show an example of a child having an experience with with something and I'll tell you before we start when the child looking in in the cup I'll show you what it is I brought it with me it's a cup like this there are Smarties in there just so that you can see of you know how you would see it so that might give you some information about what you think she might be experiencing volume here Shazam will you can you tell me if you're seeing that okay I'll tell you if I hear it yeah there's video but no audio of course not nothing okay I will narrow so this little girl pushed her cart over as she does every day and right here can you see my pointer yes right here behind the Braille writer railriders is that little cup and to this point when she's gotten Smarties I have given them to her one at a time as a reward so that is how so far she's experienced those Smarties so she just stopped leaned over and said what's that an inn by the way Susan ask this earlier but that's not generally where she gets the treats as I said they usually give them to her one at a time so I asked her to tell me she said what's that and I said show me what's in there and she's pointing into the cup and so I wanted to express something that I've learned especially when we're talking about assessment is I have been giving students information and media only about what they're seeing but especially in the in the assessment phase we want to be asking them what what do you see so I was asking her what she saw instead of telling her so you can see your sheet acid what do you think it is and she said a cup of she leans over and she pulls up the cup so she's feeling that she's getting attributes from that information that tactical information and then she said like it almost it was like an old like it confirmed what she thought so I asked her she said what is it nighttime try to reach in to get get whatever it was that she thought that it was now want you to to watch this this reach in here and then her examination of what she pulls out and you can know what it is so she reaches in perfectly she pulls it out down to her visual field which is right here lower right and she says what is that so she can perfectly reach in the cup but she can't identify yet what she's pulled out so now she says she doesn't know what it is and then she says do you want one I'm asking or what kind of candy it is and she said it looks like a can is it the end of the second it's so when you look at it from here yeah probably looks like a candy cane feels like a candy cane right in the little rapper but it's all the smarty stacked up there together and here she still offering this candy to me now I'm telling her it's Smarties she said no parties so so many things go down there but then she had that experience with all the smarties together there and another place so hopefully then she'll file that away with that experience and be able to tell the difference in Smarties and candy cane okay still give teachers Susan spoke a little bit about this and yes it's those obvious things that we recognize but what we've learned is the Australian teacher for us may not be the same Salient feature for one of our students so we have to figure out what it what is it about things that stick out to each student and then the other thing that I wanted to mention was how important it is to provide instruction and concept development and when were doing that deliberate direct instruction we're giving kiddos the foundation of language SEPTA van expressively for them to tell us what they see and for also for us to teach them what they're saying so the next area of assessment is visual clutter facing so many many Gayle this is the greatest obstacle when it comes to a cortical visual impairment and we know visual clutter and the need for spacing it can limit visual record Mission and of course of cluttered environment visually can interrupt some independent travel Samuel teneyck nosha is one of the things that our students may experience and that's only the awareness of only one object at a time so I gave an example here on our PowerPoints the pencil and the book and then let's say that the a bulletin board in the back not a couple of feet behind there with ABC's so are might be able to clearly see if a pencil clearly see a book and clearly see the abc's on the bulletin board a few feet of what a way that they can only see one of those things at a time here's another example of some concerns with with visual letter so the student here on the on the left she she loves these hidden picture experiences but what she does is she uses a line marker on top and a little pointer two to scan back and forth and that she goes she pulls the line marker over what she's already looked at she can sign the majority of these but sometimes it's difficult so we just Place another piece of a little bit more of an occlusion and she finds the object immediately so few more areas of assessment visual field so I know for me I was always thinking about visual field peripheral and but when Perkins says this assessment is about peripheral and Central and those fields can fluctuate and it's dependent on the activity dependent on visual fatigue a student may have full access to their visual fields in the morning and in the afternoon after working really hard and they can have very limited visual fields one thing that was I mean it it seems to makes it sounds silly now but I was when I thought about students with cortical visual impairment I always knew that there might be good days and bad days right so you know there might be one sensory system say a better the other so kind of like that but what I really can can truly understand now is that their visual functioning is really dependent on each activity so it could change from one activity the other from one hour to the next we won't talk about color we're all excited about color but using color in the environment as one of the the fastest ways to help a child recognize what they're looking for form accessibility 3D real objects objects in various positions so can a child identify it in different positions to the realistic color photos abstract symbols fonts and can they identify those forms in across environments and activities so that's something to assess we'll go back to our student that love hidden pictures there was she was looking for this Ladle by the way this is the magazine the Highlights magazine is turned sideways now I'm so she's looking at it from the side rather than King at it from this way as she was before so this is an example of here she's looking for this Ladle so when she first looked at the key the ladle is right side up appears right side up and she looked and she looked and I further app we did in further occluded to try to help her hone in on that Ladle and when she couldn't do it I turned it sideways so that it was in the same position as the key and she found it immediately when we talked about positioning it can be again 2D to 3D there's there's that difference that can be really difficult Matt tejan does the getting started with CDI assessments for Perkins and he has steps of cards and they provide a Target that is given in the picture from very realistic to very abstract cartoonish we know generally our students are going to do better with the more realistic pictures uncluttered easier to recognize but this is a great way for for us to see exactly what kind of pictures should definitely be used for students share some other parts Perkins split up there guided visual guidance of Limbs and upper and lower and one of the the main issues with the upper over and under reaching is it's difficult for our students to determine the distance between themselves and what they're reaching for and course Suzanne and I get really excited when their talk about lower limbs cuz then you're talking about traveling and overstepping in environment is really important I always think about that little The Mulch area on the playground and then the little barrier that you have to step over from the mulch to the playground or something like that you know something like it can always be an issue especially if there is low contrast there fatigue is at the end of the day so there they may be able to travel really really efficiently one day and in the in the afternoon it maybe more because again the impact of of using their Vision all day motion you know what we do motion for awareness cuz that's one of the things our brain instantly and picks up on but what we found with students with CBI is that they have difficulty judging the distance and the direction and the speed of things so in and motion and is it also goes for light motion light while we've used it previously and it still may be very appropriate for some of our students it can for some students it can be as to distract her from what they're trying to look at so it's not a you've got to find out how we have to find out how these these components impact each child and there's light backlighting may still be beneficial we're talking about you know tablets and white boxes boat for some kiddos they actually may experience lights in September t hey bro quick access to people and this is one that video that we really show the woman Express that she she sees a lot of emotion colors and proving things like this but she can't interpret her daughter's face so you know we're talking about students looking away initially maybe greeting someone and making eye contact but once a conversation starts they may lose that eye contact because they're listening and oftentimes they identify us as add by characteristics like our high our hair glasses and access to people is always also going to fluctuate so they may be able to recognize their teacher morning and not the afternoon so that that will also very one story that night old from Perkins was that she had to do an art project in high school and it was they had to replicate his face and they described their experience with faces as as looking and in pixels and see what they had to do was a part of the face on index card because that's what they were able to focus on one part at a time then they put all those index cards together to make a face and we know sensory integration is difficult especially when there's competing free information but add on to that now we want to look at since three integration and how they us our students my with Stevie I might need to use different channels for different learning activities so they might look for one and touch with another listen with one look for the next so they may be efficient use it but many are still efficient using one at a time one since channel what time Ella Mae's I'll talk a lot about this there are two parts to the Perkins assessment appearance of eyes and movement of eyes because as Suzanne said this is prevalent among individuals to put CDI nystagmus strabismus and those range like the alternating strabismus where kids might locate with one eye and then they examined with the other eye maybe rolling eye movements and a lot of occu oculomotor deficits like pursued those are all things that we want to look at as an additional impact to CV I kind of looked at it or or both but you know a lot of these I'm movement then end and issues are actually coming with we see a lot with CBI but she did a wonderful exam about how the I just bounced from those major Salient features that they recognized in a picture but they missed what the stories about because they're looking at the color they recognized or the largest item I found that fascinating how they followed that right so here's some examples of of issues with the contrast sensitivity then you've asked him to pay and then you add on issues with Acuity and ocular motor concerns Fields Color Light Shadows movement all of those things that's just the contrast sensitivity issue they're so we'll touch a little bit about auditory processing I'm actually going to go to this life next but auditory processing disorder also referred to Central auditory processing disorder and we were talking about that they have similar risks and it said that that one is one of the hearing just like the vision also with auditory processing just like us CBI the impact varies per individual and we want to remember that auditory processing is is diagnosed by an audiologist and CVS Scotland it and Perkins or both have great information about auditory processing concerns and CBI but here's some of the things that we might see with our our students difficulty localizing sound understanding spoken language annoy the backgrounds comprehending and following rapid speech not being able to follow complex commands learning songs and nursery rhymes maintaining attention or what and Miss under getting messages so it's worth it to consider that when we're doing a testament and trying to look at that a little bit closer for our kiddos here's just a very simple auditory processing difficult checklist on Sonic learning and again wait we don't diagnose that but it might be worth Gathering and kind of looking at if it's enough evidence to 14 to consider I will move into environmental assessment so of course this is intended to two assistant in determining specific adaptations for the environment for visual functioning Independence so we're going to focus on is the environment safe based on their visual needs does it have the sensory components present that prevent a kiddo from using best phone Vision how does light impact the student contrast clutter spacing Etc when told that you can use in this process is the what's the complexity chart this one's the Channel rating scale this is Matt teaching and one example is let's just say visual movement down here at the bottom if there is no background movement in the visual field that's what you would Circle so you Circle minimal to extreme and impact of these things sensory movement lighting and Novelty and then you you can determine that in that could be each environment to students in I wouldn't I would recommend that so as your circling that you look and and you see what areas may need to be adapted and that can be really helpful very helpful we're on to Chris Russell she gave a lot of great practical strategies for us but one thing that he expressed was the importance of increase in communication with medical Nationals in an example that he gave was providing parents with a summary of the of our our assessments and you'll see in just a minute I'll show you the section section that he uses as a c sorry. Maybe a one pager that parents can take to medical professionals would be helpful to let them know what we are seeing in the educational setting you're will you you you will want it to have increasing complexity in terms of some backgrounds that you offer to the student I think he had like four and it became and King Lake complex that he would put things on to assess a student I thought this was a great idea he recommended prior working with his prior to working with a student to ask the family to send real photos or photos from the child's world like the people they might recognize in their family or their pets and using that during assessment and he emphasized observing overdose many observations that we would do an environment get a sense of how long it takes a child to give an answer or how sure are they when they answered just like in the video earlier that you didn't hear but the little girl she just was not quite sure and that's why she kept asking and she say I don't know and it is a conversation would go on so just hang attention to two how kiddos are doing that will be important during the assessment I'm glad this is avail if you want to say more about this to please do but it's a AC and CBI Matrix so it's really great in that they that is it illegal just a couple of ages but you match up you determine if a student is an emerging presymbolic Communicator a concrete symbolic Communicator or an abstract symbolic communicator and then you do Carmen you match that up with which phase there's those faces and was talking about phase one early Phase 2 late Phase 2 and phase 3 and then when you determine that there is there are some recommendations as to like for example this is FaZe too late for emerging presymbolic communicate and when recommendation is touch cues and Tackle named juice you know what I found interesting Lee I like it when you talk about this communication is so cute and people are not taking into account have auditory receptors receiving out of her information is affected and they're going straight to text in 2D and they have a preference for what they know and do everything we went through that that. today they really talk about touch concrete objects and being very mindful into what kind of when you transition a child out of concrete in 22d and I love the way this particular matron kind of shows they have a who doesn't love pictures this it will say it how far does 14 members and families to help them understand okay so this is the word document that will be sent to participants Chris Russell has gifted and one and anyone with his with his CV eye template his report template where it's high tide does that is where you're going to put it information that specific to yours jet that you're assessing you can also probably remove his name that is fine if you can email him I'm sure he'd be happy to have an email from you too but that is where you're going to fill in your information and we have results here I'll move on to the next may be okay here on page for there's that summary of results we were talking about so that is the it can be a summary that you share with medical professionals then he has recommendations very specific also with pictures more pictures here's an example of a of a root mean and using routine to promote visual functioning goes into diagnosis and assessment and then has tons of resources to spare so we can all be thankful for that I sent him that Suzanne wanted to mention when we're talkin about I know it can be a struggle for us to always get the medical information that we're looking for one more complaining assessment but if if the team has any concerns about hearing and vision you can always get with parent consent get information get with Tennessee death on project for medical records information medical forms are not the doctor they are the people behind gas that are given test and sometimes they don't know what information is pertinent and what information is not and in fact we will I click I mark clinical notes when you ask for permission for medical information. Just my report as for the clinical notes that was it that was doctor's less when we were talking I love that I love that and we forget that sometimes it's on there but we'll forget the market and last part if you have ways that you've successfully communicated and exchanged information with local professionals and educational teams by all means please put that information in the chat and share with everybody else about how you've been been able to be successful doing that and it's all you Sissy I bet you get out mother too I think you can stop my sharing why you say that but so he could do you want me to stop okay guys I got to tell you all Leo and and I used Zoom all the time all the time our computers have been possessed we can't get the videos working we panicked before you all came and we that is why you see us doing some some struggling here a little bit and some of the stuff we're not able to show you in the way we would buy okay just tell me this do you what do you want do you see I'm going to do this summer Mega a lot of us are itinerant and a lot of us when you hear back at CVS and how in some of these strategies that we need to look at if it's not embedded throughout the day it is not working so we're going to talk about strategy we're going to talk about working with teams and we're going to talk about showing them how to get the information the teams need to know that the settings in the environment are the primary in Decatur what's tent will be dominant during that activity and most classroom teachers this is not something that usually worry about and that all learning opportunity to not have to use all the and that she take daily routine day routine she care during a movement component consideration of auditory input and communication modes those are based on who win and with whom and make them user-friendly I'm glad this video is going to work I want to talk a little bit about assessments and driving that instruction with accommodation Nazi Bi-Lo goals we talked a lot about selecting what symbols you're going to use to help with communication this particular video we're watching song about a minute it's really this child is transitioning from 3D to 2D representation for communication and that's because he's got great direct gaze he's gotten visually got it now they're really working on the high and lower lands to work so they're working with independent self-initiated movement extending their learning distance in a child's world and Variety in a 2d learning this is his mom look how control the environment stool is black background and then we're going to talk that little boy on his tummy with his mom she's pulling up iPad with the photograph of the ball he communicates by touch that he wants it in the exact item comes out so the addition teacher of course was Paramount in this on the distance but what I like look where they put the adjudication they put it down on the floor but he can independently access it and play with the item look at that support instability he still really needs to be able to play he had that visually got it rich but he had to get on him back to actually manipulate it and he's not really using it as intended yet so you can see how it is all layering and all Builds on each other and that we can't go directly just to one way of communicating I'm so sorry we can't click on this because I really love it this is showing us how to use different pains from iPad and it's the Roman word bubbling app when you get this PowerPoint you going to want to click on it it takes you straight to this thing where you type in your words you can figure out the background color you want and what you want the word outlined in and you can save it and use it very that simplified way of introducing letters and words with kids the link on the other side and Danny gave it to me just days ago is awesome it has a whole complete link of iPad apps but when you click on this picture there's a red dot by each app and you click on it and you have best Tube app and can download it and it came from Scotland it has a variety of activities so a lot of his use and iPad because it's self-contained it's that I give good direction has backlight backlighting and it's motivating and it has a lot of communication devices that can be used with in conjunction with that but we need to remember if we are using an iPad and they seem to be adjusting to 2D pictures I'm going to go back to what I said before it can't be one mode of communication there was a chow mid-spec face too so it's on the third of the CBI range and this child just like the one in the other screen was becoming very familiar with 2D pictures on the iPad but it's a challenging visual processing pad for him to use an array of objects so he gets visually achieved easily so when you start adding more choices on your iPad on your communication device you're up in the you're upping the visual movement of the eyes and I hand coordination of what you have to tuck so in addition to that he still needs it stacked a partial concrete objects calendar that allows him to accept and stay anchored throughout the day no matter how he's feeling visually so let's not close off 1 Avenue of communication Tori the visual the touch that we talked so much about that are all important we can use them income combination or we can use them sing early but we need to give the child the dealer to access it multiple I love this and when you go to the site make it easier to see I'm sorry you can't in them we want to keep a user-friendly we want everybody to be able to access the Strategic accommodations were using so going to keep it simple so by child's workcenter you you may have problem seeing multiple things but you may Sage on a chart see one thing he may have a left or right in attention do you have a three letter word phrase keep it on the ride keep it still keep it moving eyes or ears keep it short big bulb ride give me time these 3 words phrases anybody can use you put them down in any adult working with the child automatically knows without reading a whole left of what you expect at that task The Ellen gave me a wonderful blessed that she did that was laminated that she put on a ring by the activity or the person and whoever was looking at it could look at it and access accommodations easily. Cuz that's what this is all about this is not embedded through the day then we're not doing our job but this is a good link y'all click on it and then it had some great at that patients that are easily accessed here's a a really great one for setting up routines and active learning spaces and we got to remember routines on the 1st Avenues of receptive language so routines environment in touch and with this routine this was developed by Chris Russell with Christine Roman Lansky when you click on it you can talk directly on this week and you can put it in a central location for the whole team to ride when you can talk about the activity the CBI characteristics that are impacted by the ideal positioning in any adapted materials that you might need accommodations arrived at patient's so it can be written in there you can add more it's easily accessible you can have your OT or your peachy which is such an important aspect on learning and movement with our kids and you'll find it riddling you you'll like it I promise this is seen alive. I have seen this come up more and both links are active this takes you straight to steps and literacy literacy used to be thought of his reading and writing and we know that is not a good strategy for summer complex kids and that beginning reading does not start with books it does not start with brown it does not start with 2D object it starts with the foundation of relationship behavior of finding out what the child likes or dislikes and with that you build up and nobody understands that communication and all those are part of literacy I like this check list because it helps break that down into smaller steps it's great for present levels of performance you don't put teacher observation you put the dis link to the steps in literacy and academics that are growing and numeracy and it starts to little or no interest in people around them little or no interest in Rhythm or books or literacy yes no sometimes or I don't know attend to a communication partner takes tank turning takes turn-taking tivities enjoys music attends two pictures shows interest in writing materials all this is heading towards the literacy and numeracy all this is in small enough steps for everybody and the parents can use it you click on that when you get this you will see what I'm talking about the first steps of literacy what I like about it is it not only chose this checklist checklist station strategies and lesson plans God on what to do when you figure out what levels are on on their literacy and we talked a lot about this the localizing and deliberate search patterns and the reason I chose this is when you're in using the general curriculum and their child is in the classroom there are we realize the importance of picture it tells the story it's such an important step to that beginning literacy and complexity is a real issue and guess what making it bigger just make them bigger complex picture so we need to rethink about it but we also want to use what's in the classroom if it is accessible this of course is a very busy background with lots of little balls on it but we remember but even just focused highlighted white it may be more accessible or this little too I haven't used but I never yell in hands it's duct tape made into a little square got a little sick holding on it will you can help them focus on a bigger picture more complex picture to get that part and with that part you can start seeing how it fits into the that helps them scan and work through the page yes is interesting it is from Gordon on his CBI Scotland. Org when you click on that you'll see on the right side cross the top activities you click on it it takes you right to a blank string pitches caterpillar on it now where you can cut and paste whole books or phrases into that and puts it out into enlarged print will you pick the font you pick the size you pick the color you pick the background and it helps with Aidan back those face three kids that were always looking for adaptation you can adapt this was a Hungry Caterpillar within a matter of cut and paste in the very first its first words on venmo Gordon himself has shown you how easily it was to cut and paste The Hungry Caterpillar and put it and how you can control the speed and we forget when we talked about contrast it's also the distance between the letters if you're trying to get them to look at letters of course you don't want to add a line every letter you don't want every letter to be possibly the same color highlighted in their favorite color it just needs to be four important issues okay before I get here and now we're going to talk about I Pecos and I just have to confess not my favorite IP goals everybody has strong opinions on but I like the way Chris Russell diesel I didn't even change it these are his words and I like how simple easy and user-friendly they are and here's the former way fishing goes down at Paris Chanel at this stage giving a quiet controlled environment will reduced visual clutter students will look at... As opposed to the poor meal timing chain Jasmine will look I reach for her orange-colored spin place to get the black background on the table cover 03 what when where Joseph will activate the red switch to turn on the radio or pull yellow livre to obtain water from a cooler I can do that I can mark that I can tell you the progress on that and so can the classroom teacher so can the paraprofessional everybody can understand that goal was expected Phase 2 Jennifer will look at and reach for a single colored object such as a yellow cut an array of no more than three objects cup yapping and Spoon better place black background with increasing Independence and decreasing props you lost me at single color colored object or this Juniper Wellesley at and reach in her upper and her left lower field to activate switches in a preferred color to obtain object such as a comb for fine motor or self-help I can do that I know where to place I know what it is and I know what she's going to do with it with that phase 3 Ruby will maintain visual contact while reaching for targets that decrease and against increasing complex backgrounds drain functional functional routine Ruby with vision locate and identify functional indoor such as the exit sign at distances up to 20 feet and will travel to the landmark destination with decreasing amounts of assistant of course it's an o n m instructor I love that's a lot that was fast that didn't have all the link and Buzz in Banks we wanted but it it shows you how complex CDI is in the differing new place he's there and when you assess a child how it is ongoing and it really takes a change in bed it so all these skills are not going to do any good if they're just ABA goals in the students aren't using it during the day I also love how Denton doesn't separate auditory movement and vision we need to think about the whole child yeah yes Allen put a link here for the CBI companion guide the APA without 2021 and they talk about manifestations and building an individual c a profile I like that you know if anybody had looked at that well I've been in I've been in a couple of paintings with a pH in the last several weeks and it's these two ladies in New Mexico. reading it and it's been useful for them and their programming the book itself is maybe was originally written with early intervention in mind but many of they talked about how they're the way they frame it is with these manifestations of CBI that obviously travels with students still applicable with older students and so just that the way they go about it with an additional tool to everything shirt today just how we build this complete profile of KU kids are right not just like you said at the very beginning it's it's not just what a kids sees its you know who who you know how they truly experience track of everything just another resource to share with everybody else that's important also stated it real well there's so much out there good information that we can all use and I'm copying that and eat really what we did leave is that wonderful one slide that has the link to all the assessment yes that were mentioned in this will send that will add that to her and Nation as well it has both links yes yes yes a good all right I just copied that that's why I was looking away any comments are aha moments or do you disagree with some of the things we said it is when you talk about reporting and dif ways and different philosophies it's very interesting to see how they trying to collaborate and work together you know I noticed that sometimes as I'm doing what webinars are at the Symposium are talking to different people some people are very specific very specific about using phases and I think that's what's familiar to us as far as is talking about those two given idea I'm kind of wear are functioning may be visually but then other people aren't using that that those words at all I felt like I offered the whole weekend with did anybody all hot all today is it Friday Haley Allen this is Anna. I want to see call you guys did an awesome job and I always learn so much when I listen to you and Suzanne and 2nd and yes I think that we can all say that the world of CBI is exploding right now and there's so much information out there I'm in so many great people working in the field and Chris Russell and Dawnstar all fabulous people on one of the things I thought about as you were talking and I I thought about this but it really there was an aha moment we're doing so much raining right now with Ariana with vision and with our occupational therapist but really we've got to bring the whole team in and it's going to be really important just like you were talking about as you were talking about the a a a c in The Matrix you know for our speed I mean that's that's going to be huge and making sure that it's that speeds and TT are also on board and understanding the students vision and what works and what doesn't work because I know so many of us have worked with some of our Speech Pathology and some of the things that they were expecting of our students may not be physically possible and so I think that's going to be important to remember that we have to work together as a team that's a really good point. and we also if they're signers if we're including signs we need to be really careful with what signs we start with the help that you be more Concepts more action words than abstract we tend to go more abstract we understand it better we need to hang from the child's perspective we don't want communication to be a vision test every time they try to use it we don't want to be a motor skills test you want it to be at least a way to express their needs and wants in a timely manner because it's hard enough to retrieve the information to tell you about it if they have to go through another step to get it to then you get frustration and you lose your joint attention and it is can be a struggle struggle and we forget also that Owen M instructors CDI is a different animal and how we work with that I would work with kids with CBI now and then I will mention something that we own said that really really was working for me A lot of times we were working with kids and we're so used to I guess we can maybe I probably do sometimes I'm just feeling like I'm the boss I I'm going to ask the child okay so tell me about this or whatever or here's what you're going to look at and just a little more us directive in that video that you showed that little girl so young but you're so able to communicate what do you use to I love just sometimes just I probably don't think enough about giving kids credit to be able to describe experience especially young ones but earlier than than later I think we can definitely hope to see you and work on those descriptors of you know if I put this in front of you what is it that you're staying and that that could make all the difference in just giving some insights into what that complete experience is as they look around and you know a little bit about their personal feelings so I really like that we on video development she knew Smarties but you put Smarties in the package it's a whole different thing it's a whole different learning activity that was that was a great video I was I was thinking of to that those that would be a similar experience that we would provide maybe to a child who is totally blind right they would be working on those tactical skills in and other attributes but but this little girl was doing that in addition to building that visual Behavior or that recognition of Smarties in that you know in that way so it's almost you can think about well if a child was totally blind what would I do and then added you know those alien features in that a in the that information about cabbie Larry that you can give them to I was assigned a picture for her smarty was small and round you just totally changed though and beautiful reach but then within inches of horizon to visulite user Vision I mean if you just saw her although Smarties close I would have never guessed that she could reach directly into a white cup and reach in there and get what she needed so they're they're all very different evangelist Virginia I was I just sent you a text it's funny about because I'm sure I'm giving away my age but it just blows everything I thought I knew about CDI out of the water because when I when I was coming through the program you know Christine Rome and that was all we had and so just amazing it's fascinating she is the Godmother that is for there's so many voices down and to respect our I'm reading your text as we do this it's something and that you just have to keep learning and changing with an opportunity like that sticker getting the upper Limbs and lower land and isn't own image person that's so important to me and even as we saw a little boy getting the ball great iPad still had to roll over on his back and he still wasn't playing with well that I had he wouldn't bring it to midline and holding it up we assume that they've got the direct gaze and you can reach it that you have those other physical skills and you don't and you don't you mean we're blessed hearing county rottet & Speech teams they're always so willing to work with us so we're we're very blessed Vision teachers that are just coming out the reason for gin that is so I had such a great team is cuz she knows how to be a team member thank you she brings her knowledge and she listens to other disciplines and words together and that's on the way that it's going to be successful for the child and I know we have some food here and I wanted to express you know this is a perfect example of how we are always learning and now we can be in in and do what we do for a long time and still I mean again I feel like Virginia my mind was blown in terms of like and it's not necessarily old and new new but it's what we used to know we knew knew and what we know now so it's like this changing just as your folding this into the next part in a way so welcome to vision this is Jasmine just on the same vein of kind of old and new shifts or what we knew to what we know shifts and can you guys talk a little more about the the the split between on Phase 2 Anna peoples conversation and maybe what you guys pull from that conference on what people are saying about the phases of CDI I'm going to look at that your Jasmine I think that it looks like then you might know off the top of your head but it has a lot to do with Jean occasionally I want to do with 2D it has a lot to do with transitioning from that 3D object and using touch being able to translate that Central Division in Winston-Salem find cabinet that filing cabinets full you got that library and then you can extend it to make General's visual assumptions on the bike a cup a cup in a cup well face to may be able to look at a variety of Cups second half and they need to still be those really familiar Holly Staley and Yellow Cup on a black background and I can reach it and use it and I may even be able to recognize it in a photograph but then you put it in an array or you put a variety of cups in pets getting Ward late phase to do it the more sophistication of layering lie I was looking here and says a face too late as 6:55 is the range of those bigwigs and CBI and the fact that Ellen Menzel quite frankly said we don't even really like each other too well so it was I would love to have just listened well as we get towards the end here I want to keep prompting does anybody have any other profound thoughts that have come out questions about just your your your interactions with kids who have CBI or unique characteristics and behaviors that you seen or tips that have also been interesting to you it's Friday it's Friday medical records that's what I take away well if we're more or less finished or that do not have any more questions I'm going to absolutely think we all in and Suzanne today for being here to share the synthesis of your all these your newer your perspectives on how to look at CDI in addition to your solar older methods and and you know it all just adds to the toolkit right and allows us to darndest to serve these kids well in understanding them well and I'm definitely keeping them sensor and they are our valuation in construction so thank you guys for being here and I'm going to stop this recording and then we can finish this thing on

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