Cortical Visual Impairment in Children:

Presentation Intervention, and Prognosis in

Educational Settings

Suzanne H. Swift
Roseanna C. Davidson
Linda J. Weems

An Article Published in

TEACHING Exceptional Children Plus

Volume 4, Issue 5, May 2008

Copyright © 2008 by the author. This work is licensed to the public under the Creative Commons Attri-
bution License
 Cortical Visual Impairment in Children:
Presentation, Intervention, and Prognosis in
Educational Settings

Suzanne H. Swift
Roseanna C. Davidson
Linda J. Weems

Abstract

Children with cortical visual impairment (CVI) exhibit distinct visual behaviors which are often
misinterpreted. As the incidence of CVI is on the rise, this has subsequently caused an increased
need for identification and intervention with these children from teaching and therapy service
providers. Distinguishing children with CVI from children with other types of visual impair-
ments in intervention designs and other educational planning is crucial to designing effective
programs. To assist to this end, presentation “hallmarks” of CVI are outlined in this paper, as are
recommended treatment strategies for optimizing visual performance.

Keywords
cortical visual impairment, visual disorders, vision problems

SUGGESTED CITATION:
Swift, S. H., Davidson, R. C., & Weems, L. J. (2008). Cortical impairment in children: Presenta-
tion, intervention, and prognosis in educational settings. TEACHING Exceptional Children Plus,
4(5) Article 4. Retrieved [date] from http://escholarship.bc.edu/education/tecplus/vol4/iss5/art4
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! The number of students with cortical “brain-based,” always involving the neural
visual impairment (CVI) attending public pathways and/or the brain itself. Visual in-
schools is increasing (Ferrell, 1986; Flod- formation is relayed through the eye as it
mark, Jan, & Wong, 1990; Jan & Wong, 1991; should be; however, the brain cannot always
Morse, 1990; Whiting et al., 1985). Because make sense of the information it receives
children with CVI present with different (Baker-Nobles & Rutherford, 1995; Flodmark
strengths and weaknesses than children with et al., 1990; Jan & Groenveld, 1993; Morse,
other types of visual impairment, this necessi- 1999).
tates a critical rethinking of the traditional Causes of CVI reflect this brain-based
interpretations of visual impairment (VI) as definition and are remarkably diverse.
an “ocular” disorder involving only the eye. It Hypoxic/ischemic and other “lack of oxygen
also means that we, as service providers, will to the brain” accidents are presently recorded
need to reformulate any preconceived stereo- as the leading cause of CVI and usually occur
types we may hold about “children with vis- during or shortly after birth from complica-
ual impairment” and how tions of prematurity or
we should teach them. Causes/Associations of CVI. other gestational/delivery
This fundamental distinc- difficulties. CVI can also
tion is especially crucial • Lack of oxygen to the brain result from later occurring
as research now indicates • Intracranial pressure/hydrocephaly
events that result in de-
that interventions condu- creased cortical oxygen
cive to increasing per- • Brain malformations/head injury and/or damage to brain
formance with ocular im- tissue such as cardiac
• CNS infections (meningitis, CMV)
pairments may be largely arrest/respiratory failure,
ineffectual or even detri- • Poisoning/drug exposure increased intracranial
mental when used for pressure, head trauma,
children having cortical • Prematurity/birth trauma hydrocephaly, and/or
visual impairments (Far- • Cerebral palsy
shunt failure. Congenital
renkopf, McGregor, Nes, brain malformations sec-
& Koenig, 1997; Groen- • Seizures/Epilepsy ondary to genetic syn-
veld et al., 1990; Morse, dromes and/or other birth
1990). defects are also impli-
cated in the incidence of CVI, as are CNS in-
Definition and Etiology fections like meningitis, cytomegalovirus,
Cortical visual impairment is un- encephalitis, and herpes simplex. Poisoning,
known to many teachers and therapists. Stan- certain drug exposures (e.g., Cisplatin), vari-
dard explanations of CVI specifically con- ous sedating anticonvulsant drug therapies,
sider where the disorder occurs, predomi- carbon monoxide poisoning, intrauterine co-
nantly referring to a visual loss caused by caine exposure, and accidental ingestion of
some disturbance to the “posterior visual other drugs or chemicals can also cause or
pathway” or “visual cortex” which encom- exacerbate CVI. Finally, secondary complica-
passes difficulty in processing and interpret- tions such as seizures, metabolic diseases,
ing incoming visual information. This may be hypoglycemia, and progressive genetic syn-
simplified by thinking of CVI as inherently dromes may cause or intensify cortical visual
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impairments (Flodmark et al., 1990; Good et other coexisting disabilities. Cognitive im-
al., 1994; Groenveld et al., 1990; Jan & pairments, cerebral palsy and/or other physi-
Wong, 1991; Kivlin, 1993; Wong, 1991). cal challenges, significant learning disabili-
ties, and moderate to severe communication
Incidence and Considerations difficulties are all highly correlated with con-
The incidence of CVI is less well es- comitant CVI. To complicate matters further,
tablished than its cause and, historically, students with CVI are generally more difficult
under-identification has been the rule rather to diagnose than children with complete
than the exception; however, according to blindness and may experience delayed refer-
Good et al. (1994), CVI “can now be consid- ral and/or treatment due to inaccurate percep-
ered one of the major causes of visual im- tions about their residual vision and their ca-
pairment” (p. 900). As children with CVI may pabilities for visual improvement (Groenveld
present somewhat different characteristics et al., 1990).
across diagnostic etiologies across their life-
span, identifying a “set” profile that accu- A “New” Disability
rately describes all persons having CVI is par- CVI has been relatively unexplored as
ticularly difficult. It may occur in pre-term/ compared to more traditional ocular disor-
full-term infants, pre-school/school-aged ders. As a result, the visual difficulties of
children, and also adults. It may be congeni- children with CVI are not well defined and
tal, acquired, temporary, permanent, and even the educational implications of these impair-
occasionally progressive (Jan & Wong, 1991; ments are only marginally documented
Whiting et al., 1985). It classically occurs in (Baker-Nobles & Rutherford, 1995; Jan &
tandem with central nervous system (CNS) Wong, 1991). Children with CVI may be
disorders and so may be masked or difficult found in both general and special education
to isolate as a result of concomitant cognitive, classrooms and often present with primary
motoric, language, and unrelated ocular defi- labels of cognitive impairment, other health
cits (Good et al., 1994; Morse, 1990). It has impairment, attention deficit disorder, or even
been called by many names: cortical blind- autistic/behaviorally disordered. When the
ness, cerebral blindness, double homonymous visual behaviors of these children are consid-
hemianopsia, occipital blindness, infantile ered in conjunction with their educational di-
cerebral blindness, visual agnosia, visual ne- agnoses, they may inadvertently be excluded
glect, absolute scotomata, and functional from visual rehabilitative services due to mis-
blindness to include a few, largely misleading conceptions regarding the cause of their
terms as children with CVI predominantly atypical behaviors (e.g., when they turn away
have some residual vision (Baker-Nobles & from presented stimuli, this may be inter-
Rutherford, 1995; Farrenkopf et al., 1997; preted as an attention or behavior problem
Flodmark et al., 1990; Morse, 1990). rather than as a by-product of their attempts
Though not blind per se, children with to reduce the number of items in their visual
CVI may function as blind due to their brain’s field or “visual crowding” issues). When re-
inability to recognize or analyze signals re- ferral for ophthalmologic testing and/or func-
ceived by the eye and anterior visual pathway. tional vision evaluation and services does oc-
Children with CVI also tend to have widely cur, students with CVI may be judged “untes-
fluctuating vision and are often affected by table” due to limited mobility and/or commu-
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nication skills, further complicating the deliv- in different visual losses dependent upon the
ery of services. extent of oxygen deprivation, the exact area
With all these variables, the identifica- of the brain deprived or damaged, and even
tion and understanding of cortical visual im- the age of the brain that was damaged.
pairment may be difficult indeed for the vi- Another explanation for the difficulty
sion professional, the classroom teacher, and in isolating fields of visual loss/extent of vi-
other diagnostic and sion deficit may be ex-
related services person- plained by the high co-
A Few Terms:
nel. Though the diagno- occurrence of ocular
• Visual acuity: The eye’s ability to distin-
sis of CVI remains a (eye) impairments and
guish object details and shape.
medical decision by an cortical (brain-based)
• Ocular visual impairment: A visual
ophthalmologist, this visual impairments. As
problem caused by damage to the eye.
paper is intended to as- reported by Whiting et
• Cortical visual impairment: A visual
sist educational and al., (1985), up to 60%
problem caused by damage to the visual
therapy professionals areas in the occipital lobe of the brain. of children with CVI
who may encounter • Eccentric viewing strategies: Assuming
were also identified
such children in identi- unusual head postures in order to “look with concomitant ocu-
fying, referring, and out of the good part of the eye.” lar impairments. This
working effectively • Nystagmus: Involuntary, rhythmic side- notably complicates the
with children having to-side or up-and-down eye movements. differentiation of the
CVI. • Strabismus: Misalignment of the eyes two and makes identifi-
caused by imbalance of the eye muscles. cation and intervention
Visual Loss in CVI: • Exotropia: Strabismus with the eye inherently more com-
“Hallmark” Signs and turned outward. plex, especially when
Symptoms - Cassin & Solomon, 1997 c o n s i d e r i n g a n
Students with assessment/treatment
cortical visual impairment may have widely design that will adequately address the indi-
differing visual losses. Variations in degree of vidual characteristics and needs of each dis-
visual loss, fields of visual loss, and even tinct problem. Fortunately, the “classical”
fluctuation of visual performance are quite signs of cortical visual impairment tend to be
typical across children having CVI. This may somewhat similar from child to child when
be due to multiple reasons. Various severities the knowledgeable professional knows what
and ranges of loss may be attributed to “brain to look for. The following section will address
shearing” and coup/contra-coup injuries dur- characteristics of this distinctive behavioral
ing traumatic onset (the twisting and bounc- profile.
ing of the brain in the skull that results in the
disconnecting of pathways and then bruising Physical Presentation (Eye Findings)
to the cortical tissue). The site of lesion dur- Children with CVI may have no nota-
ing epileptic seizures may also account for ble eye disorders, though strabismus may be
differences (the specific part of the brain notedand could be an early sign of cortical
where the electrical “short/overload” occurs). visual impairment, especially if consistent
CVI related to brain damage from ischemic exotropia is present (Good et al., 1984). In
events/interruption of oxygen will also result addition to possible strabismus, a slight motor
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nystagmus may also be present in the form of able visual performance is noted from day to
an unsteady gaze or poorly coordinated/jerky day and even hour to hour, sometimes leading
eye movements (Baker-Nobles & Rutherford, professionals and parents alike to suspect ma-
1995; Jan & Groenveld, 1993). This motor lingering (i.e., “faking”) on the part of the
nystagmus is normally the direct result of im- child (Good et al., 1994; Jan & Groenveld,
paired cortical control and should not be con- 1993). Students with CVI have also been ob-
fused with the sensory nystagmus often seen served to create close viewing situations by
in children with ocular visual impairments. bringing objects very near their face and eyes
Sensory nystagmus, (Baker-Nobles & Ruth-
the obvious instability Visual Behaviors Explained erford, 1995), and up to
of eye fixation, is vir- one-third of children
• Visual latency: Delayed or slowed visual
tually nonexistent in with CVI show a char-
responses.
children with cortical acteristic head turn
• Visual attention/gaze behaviors: What is
visual impairments un- when reaching for ob-
noticed and for how long.
less CVI resides con- jects: they look away
• Visual novelty: Looking at both new and
currently with another from what they are
familiar objects.
ocular impairment. reaching for as they
• Visual curiosity: Exploring items visually
Likewise, eye pressing, reach for it (Good, et
and seeking stimulation.
head shaking, and ec- al., 1994; Jan & Wong,
• Visual field restrictions: The loss of pe-
centric viewing strate- 1991). This close view-
ripheral vision.
gies should NOT be ing and head turn, used
• Depth perception: Using vision to judge
noted in students with to reduce the number
distance to and from objects.
cortical visual impair- of items in the visual
• Figure-ground perception: Separating the
ment unless CVI is co- field (decrease visual
background from the foreground to distin-
existing with ocular guish the borders or “shape.” crowding), to maintain
disabilities (Baker- • Visual crowding: Too many items in the visual attention, and to
Nobles & Rutherford, visual field at one time. allow for selective pe-
1995; Jan & Groen- ripheral viewing are
veld, 1993). often misinterpreted as
purposeful gaze aversion, task rejection, or as
Behavioral Presentation rebellious misbehavior, particularly after the
(Performance Findings) child has been directly instructed to “look” at
Children with cortical visual impairments in something specific by an authority figure
educational settings will show at least some (Baker-Nobles & Rutherford, 1995).
behavioral consistencies. The overwhelming Other signature features of cortical
presence of visual latency, poor visual visual impairment are visual field restriction
attention/limited visual attention span, and and peripheral field loss. Poor depth percep-
extremely shortened gaze behaviors is one of tion and poor figure-ground perception are
the most frequently reported hallmarks of also characteristic. Increased spatial confu-
children having CVI, often resulting in fre- sion further distinguishes this group, though
quent misperceptions of these children as in- color perception has been reported as intact.
capable, inattentive, or poorly motivated. To A preference for brightly colored objects
further compound the situation, a highly vari- (specifically red and yellow) has also been
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reported (Anthony, 1994; Good et al., 1994; mental delays, treatments that incorporate
Groenveld et al., 1990; Jan & Groen- neural based stimulation methods and natural
veld,1993; Morse, 1990). developmental sequences are preferable.
The majority of children with CVI Capitalizing on natural inclinations such as
additionally show a coincident preoccupation our inherent predisposition to notice faces,
and aversion to light. According to Jan & movement, high contrast, and bright colors
Wong (1991), light gazing may be ob- are highly recommended. This aids in
served in roughly 60% of all children with maximizing visual attention and residual
CVI. The presence of mild, but persistent, vision. Specific to this, the following sugges-
photophobia in nearly one-third of children tions are proposed:
with CVI has also been •Use movement. Chil-
reported (Jan & Gro- dren with CVI can of-
Some Signs and Symptoms of CVI:
enveld, 1993; Jan, ten locate moving
Groenveld, Anderson, • Visual latency and poor visual attention/ stimuli with greater
shortened gaze behaviors.
1993). Difficulty with speed and accuracy, as
visual novelty (a pref- • Highly variable visual performance. well as maintain atten-
erence for looking at • Head turn when reaching for objects and tion to moving stimuli
familiar items), along- close viewing behaviors. for a longer period of
side poor visual curios- • Difficulty with visual novelty and poor vis- time. Include move-
ity (limited visual no- ual curiosity. ment in all interven-
tice) has also been ob- • Visual field restrictions and peripheral field tions until locating,
served. The final fea- loss. tracking, and maintain-
ture strongly correlated • Poor depth/figure-ground perception and ing visual attention is
with CVI involves the poor shape discrimination. improved (Anthony,
associated neurological • Light gaze fixation/photophobia (a 1994).
deficits that are typi- preoccupation/aversion to light). •Use high contrast
cally concomitant with • Preference for brightly colored objects, often (black print on white
this condition. Though yellow and red. paper, yellow picture
not all children with • Associated neurological deficits resulting in on black background,
CVI have multiply in- cognitive, motor, and communication etc.). Visual attention
difficulties.
volved systems, the to high contrast grat-
vast majority do seem ings using black and
predisposed to poor motor tone and decreased white stripes are excellent first options,
mobility. Global speech-language problems followed soon after by checkerboards and
are additionally noted in both receptive and bulls-eyes. High contrast colors such as
expressive areas, with depressed verbal com- red and yellow should be presented
munication being customary in these children. against various backgrounds to determine
what the child sees best (Baker-Nobles &
Methods for Intervention Rutherford, 1995).
Effective interventions for children • Use boundaries and borders. The simple
having CVI can differ substantially from inclusion of high-contrast borders or
techniques used with ocular impairments. As wide-width boundaries may provide sig-
CVI tends to coincide with global develop- nals to the child about where to look (e.g.,
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 place a thick black line between objects or • Ensure appropriate lighting. The child
draw strong boxes around text you want with CVI may require decreased bright-
the child to focus on). This encourages ness and/or glare due to light sensitivities.
attention and improves gaze behaviors. Use various lighting types (e.g., incandes-
Borders may be created in various colors cent, fluorescent, halogen, ultraviolet) in
using easily discriminated tactile materi- conjunction with supplementary modifica-
als to provide ancillary tactual cues for the tions such as visors, tinted lenses, etc.
student (Anthony, 1994). (Groenveld et al., 1990).
• Use simultaneous touch and vision. If the • Use technology. Electronic media is easily
student is presently using touch cues to manipulated to adjust size, color, contrast,
assist in identification, pair these cues and brightness for those higher function-
with meaningful visual training to map ing students who have little difficulty with
visual images to established tactile per- representational tasks or transfer of func-
ceptions (Baker-Nobles & Rutherford, tional skills. Auditory signals can also be
1995). adjusted to ensure appropriate signal-to-
• Use selective colors. Note the child’s noise ratios and clear auditory cues
color preferences and dislikes. As men- (Baker-Nobles & Rutherford, 1995).
tioned previously, red and yellow tend to • Select stimulus materials carefully. The
be very effective first choices. Tailor- use of common, familiar, high frequency
make interventions for each child using objects may assist students in forming ac-
preferred colors whenever possible until curate and representative mental con-
visual attention to other colors can be es- structs about these objects and their prop-
tablished (Anthony, 1994). erties, particularly as students with CVI
• Simplify the visual environment. Avoid attend better to the familiar (Groenveld et
extraneous stimulation, stimulus competi- al., 1990). Real objects are further rec-
tion, and indiscriminate visual bombard- ommended to ensure that children with
ment by controlling the type, intensity and associated neurological deficits do not
duration of sensory information presented. encounter unnecessary obstacles in the
Present one item at a time until the child transfer and generalization of learned
is able to tolerate and discern between 2, skills to functional settings (Anthony,
3, and 4 objects progressively and can se- 1994).
lectively attend to and/or visually dis- • Allow adequate time for responding and
criminate between items. Items should be processing. Students with CVI will need
rather large and brightly colored initially, additional time to make sense of incoming
fading to more normalized stimuli as the visual information and to recognize pat-
child progresses (Groenveld et al., 1990; terns in what they see. When CVI is pre-
Jan & Wong, 1991; Morse, 1990). sent along with neurological deficits, time
• Fill the visual field. This may be done delays in processing information often
through use of close viewing, picture en- occur and the teacher will need to allow
largement, or even magnification. Bring additional time for the child to answer be-
in objects from the peripheral field of vi- fore providing any further stimulation.
sion and progress to more central fields Expect delays of 10-60 seconds at the
(Anthony, 1994). minimum (Anthony, 1994; Morse, 1990).
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• Use multiple (but consistent) approaches. position, and even hunger levels prior to
As pointed out by Morse (1999), many beginning treatment sessions (Groenveld
children with cortical visual impairment et al., 1990; Morse, 1990).
will show a different compilation of defi- • Pair verbal and tactile cueing with asso-
cits and behaviors. Though each child ciated language concepts. Actively de-
with CVI may retain characteristics simi- velop the language needed to describe
lar to other children with CVI, the specific both objects and concepts as a primary
combination of deficits they may exhibit part of intervention (Groenveld, et al.,
will likely exclude any single, inflexible 1990). In addition, use verbal information
approach (Jan & Wong, 1991). to describe what the student is seeing and
• Use physical prompts. Full or partial feeling. Respond contingently using var-
physical assist may be needed during ied intonation cues (Anthony, 1994).
early training efforts. Physical prompts • Schedule frequent opportunities and les-
such as touching the child’s elbow to cue sons specifically for using vision. Inter-
them or even using hand-over-hand “do it vention with infants and preschool popu-
together” formats can lations should be intense,
be quite successful in Why Do Children With CVI Turn Their with scheduled stimula-
assisting children Head When Reaching? tion of 5 days per week, 2
The presence of a head turn when
having CVI to acquire times per day, up to 12
functional skills (Far- reaching for objects has commonly minutes daily for one
renkopf et al., 1997). been attributed to efforts in maintaining year recommended (Pow-
• Separate complex or focus on stationary objects (so they will ell, 1996). Adjust sched-
multidisciplinary not divert their visual attention from the ules for older children to
treatment goals when stimulus to their moving hand as it en- consider factors such as
needed. If visual ters their visual field), simultaneously severity of need, toler-
training is the purpose ance for intervention,
decreasing visual crowding. It may
of a particular ses- prior visual training and
also be used to help a child see what is
sion, minimize com- progress accordingly.
peting demands on presented through use of their more • Consider the child’s
the child’s system. efficient peripheral vision. physiological and psy-
For example, if pos- chological state. Treat-
tural support is ment times should be
needed, make sure it is given during vis- planned around optimum alert levels
ual training periods. This will ensure that whenever possible. Observe the child
children will not spend all their energies across multiple settings and time periods
on maintaining upright sitting rather than during daily routines to determine their
on targeted visual tasks. Maximize visual most favorable intervention times. Take
efforts by minimizing other requirements problem periods into account when
during interventions until such time as the scheduling difficult tasks. Remember that
child is able to handle therapeutic co- some children may frustrate and/or fatigue
treatment without distress or accelerated after a matter of minutes. Providing pre-
fatigue. Ensure that the student is com- dictable routines and structure during les-
fortable with lighting, temperature, sitting sons may help alleviate this tendency, as
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 may changing tasks frequently (Anthony, learned skill requiring opportunity, guided
1994; Groenveld et al., l990; Jan, & experience, and supportive feedback for
Leader, 1990). refinement (Anthony, 1994; Morse, 1990).
• Start each session at a level the child can • Understand that be-
perform. Success is havior and movement
Some Useful Interventions for CVI:
crucial to motivation are often communica-
and perseverance. • Use movement. tion. In the absence of
When failure occurs, • Use high contrast (colors, boundaries, a more sophisticated
look carefully at the borders). system, children with
.•
chain of preceding Use simultaneous touch and vision multiple disabilities
events. Look for be- • Simplify the visual environment. will express them-
havioral antecedents • Fill the visual field. selves in “non-
and error patterns to . traditional” and some-
• Ensure appropriate lighting.
assist in determining times undesirable
reasons for break- • Use technology. manners. Analyze be-
down. • Select stimulus materials carefully. havioral chains to
• Encourage active • Allow adequate time for responding/ comprehend what
learning and use processing. students are telling
i n t r i n s i c a l l y • Use multiple and consistent approaches. you. Respond to the
motivating/rewarding • Use physical prompts. content rather than
stimuli. Recognize method of delivery
• Separate complex treatment goals.
the cues that your (e.g. , knocking mate-
students are giving • Pair verbal/tactile cueing with language. rials from a table as a
you regarding their • Make opportunities for training visual signal of rejection,
readiness and respect skills. closing their eyes and
what the child is tell- • Consider physiological/psychological bowing their head as
ing you (either ver- state. an indication/
bally or nonverbally). • Start sessions at levels the child can communication of
Select stimuli that are achieve. fatigue).
interesting to the • When failure occurs, look at preceding •Ensure that all team
child and allow the events. members are informed
child to show prefer- • Encourage active learning. and involved. All service
ences among teacher • Use intrinsically motivating/rewarding personnel must under-
chosen materials. stimuli. stand how CVI affects
Encourage the child • Remember behaviors may be communi- intervention so that
to be an active agent cation. treatments can be maxi-
in his/her sessions by • Keep team members informed and in- mally effective Team-
building in these volved. approaches will also en-
choice-making ac- • Consider less inclusion. courage carry-over to
tivities. Use naturally • Remember that CVI is seldom “cured.” additional functional set-
occurring reinforcers tings (Jan & Wong, 1991;
whenever possible. Morse, 1999).
Remember that decision-making is a
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• Consider less inclusion. Though full in- The prognosis for “recovery” from
clusion is undoubtedly beneficial for some cortical visual impairments is mixed. While
students, the least restrictive environment nearly all studies agree that some degree of
must be the one in which the child can visual improvement may be expected in the
gain the highest level of educational and majority of children (Jan & Wong, 1991), age
social benefit. As children with CVI may of onset, degree of severity, and site of lesion
present with visual crowding problems, continue to dictate probable recovery. It is
fluctuating alertness, concomitant neuro- presently believed that children with more
logical deficits/health impairments, and diffuse and global damage have the poorest
have difficulty trans- prognosis for recovery
ferring skills to new Where to go for more information….. (Wong, 1991). In addi-
environments, fewer tion, secondary condi-
people involved in • http://www.aph.org/cvi/index.html: The tions such as seizures,
intervention may fa- American Printing House for the Blind respiratory stability, and
cilitate more success- (APH) website contains articles, videos, appropriate intervention
ful results for the case studies, and numerous educational are significant variables
student. This is par- and advocacy supports relating to effec- affecting the level and
tive services for children having CVI.
ticularly true when duration of student re-
speaking of children • http://www.dblink.org/lib/topics/cvi-bib. covery.
with multiple sensory htm: This link will lead you to DB- Though recovery from
impairments (Groen- Link, a clearinghouse of information on CVI is most dramatic in
veld et al., 1990; Jan deaf-blindness and related issues. Sev- the first 12 months of
& Wong, 1991). eral articles and resources for CVI can life, improvement con-
• Finally, remember be accessed here. Intervention activities tinues in a gradual nature
that CVI is seldom are included. for several subsequent
“cured.” Though • http://blindness.growingstrong.org/eyes years for up to 2-5 years
children with cortical post onset, perhaps even
/cvi.html: This site contains links to
visual impairment CVI and resources for help. persevering into adoles-
typically improve, cence (Flodmark et al.,
even children who 1990; Jan & Wong, 1991;
appear to have gained “normal” vision Kivlin, 1993). Most authors agree that chil-
may still show intermittent difficulties. dren receiving meaningful and consistent in-
Classroom descriptions such as “inatten- tervention who show little improvement in
tive” and “distractible” may be indicators the first 1! to 2 years after acquiring CVI are
that CVI continues to challenge the child. less likely to show recovery (Groenveld et al.,
Likewise, those working with children 1990). At this time, CVI resulting from birth
having more severe disabilities in con- asphyxia, postnatal hypoxia, and seizure dis-
junction with CVI should remember that orders report the poorest prognosis for object
progress is made in small steps. Some re- vision (Chen, Weinberg, Catalano, Somin, &
sults are best measured qualitatively Wagle, 1992).
rather than quantitatively (Morse, 1999).

Prognosis
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 Implications and Conclusions
Cortical visual impairment is the
“leading cause of bilateral visual impairment
in children in Western countries,” (Good, Jan,
Burden, Skoczenski, & Candy, 2001, p. 56.).
Children with CVI present as a distinct sub-
group of children having visual deficits who,
though often showing co-existing ocular im-
pairments, also show markedly different vis-
ual behaviors which can be recognized with
careful training. These differences call for
separate and individualized intervention ap-
proaches to facilitate improvement. As chil-
dren with CVI virtually always have some
form of neurological deficit in addition to
their visual difficulties, a team approach for
intervention is crucially needed.
Research has substantiated that chil-
dren with CVI are not malingering, do not
have inherent behavior problems, and are not
inherently poorly motivated: their ability to
use their vision really DOES fluctuate across
time and situations. The literature has further
made clear that the unusual attending and
gaze behaviors seen in these children are used
for a reason, predominantly as attempts to
self-compensate for visual difficulties. Most
importantly, research has incontrovertibly es-
tablished that some level of improvement can
nearly always be attained in the visual capa-
bilities of children with cortical visual im-
pairment. In light of these findings, it be-
comes critically urgent that service profes-
sionals recognize the relevant symptomology
of CVI and provide appropriate and timely
interventions for these students.

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About the Authors:

Roseanna C. Davidson is an Associate Professor in The Virginia Murray
Sowell Center for Research and Education in Visual Impairment at Texas
Tech University in Lubbock, Texas."
"
Linda J. Weems is a Professor of Communicative Disorders and Graduate
Dean at Eastern New Mexico University in Portales, New Mexico. "
"
Suzanne H. Swift is an Associate Professor of CDIS and Department Chair
for Health and Human Services at Eastern New Mexico University in Por-
tales, New Mexico.

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