Introduction
Cerebral Visual Impairment (CVI) is directly linked to visual impairment, as it often causes issues related to vision in children across the globe. Some of the most common causes of CVI are traumatic brain injury, ischemic damage, metabolic issues, structural brain anomalies, and chromosomal aberrations (Roman-Lantzy, 2007). In the literature on visual impairment, CVI can be regarded as a neurologic visual impairment. Speaking of the prevalence of this condition, almost 7% of American children aged below 18 have been diagnosed with an eye and vision condition. Another crucial element of statistics on CVI is the growing percentage of young children who become blind or seriously visually impaired before puberty (Lehman, 2012). These children have difficulties with vision even when wearing contact lenses or glasses. Ultimately, almost half of American children with visual impairments are exposed to the damaging effects of CVI. According to Philip and Dutton (2014), developmental disabilities can be associated with CVI as well.
The evolving nature of CVI also has to be highlighted when discussing visual impairments and their impact on children. Deficits associated with complex visual tasks have to be covered when dwelling on children with high-functioning CVI (Roman-Lantzy, 2007). In other words, conventional methods of addressing visual impairments have to be replaced with innovative alternatives in order to prevent mortality and increase survival rates among preterm infants. The younger populations of children are affected by CVI because of multiple comorbid disabilities. In line with Lueck et al. (2019), there are care and learning environments that are not equipped appropriately to take on children with CVI and engage them in respective processes. Therefore, difficulties of identifying and mitigating visual impairments to prevent CVI keep prevailing, turning the latter into a global problem that has to be addressed via improved diagnosis and treatment.
Description of Blindness and Visual Impairments
The primary factor that sets the tone for the further discussion of blindness and visual impairments is that numerous therapists and teachers have never been exposed to cortical visual impairment (CVI). This means that there have to be several standard explanations that consider the occurrence of the disorder in the first place. For example, the loss of vision could be caused by visual cortex disturbances or the impact on the posterior visual pathway (Merabet et al., 2017). The majority of visual impairments can be associated with difficulties in both processing and interpreting all kinds of visual information attained by an individual. Thus, the simplest explanation for CVI would be to consider those brain-based, meaning the brain itself or certain neural pathways have contributed to the impairment (Swift et al., 2008). The problem is that the brain does not always recognize the information it receives from the eye. Therefore, issues contributing to the development of CVI could be exceptionally diverse.
As stated by Watson et al. (2007), one of the leading causes of CVI is the lack of oxygen being transported to the brain. This challenge becomes the most visible after premature childbirth and delivery difficulties. The resulting effects are often too strong to be mitigated by the human organism, with numerous links arising between a variety of conditions. For example, decreased cortical oxygen could cause increased intracranial pressure, hydrocephaly, cardiac arrest, or shunt failure (Roman-Lantzy, 2007). There is an extended list of health issues that could contribute to the incidence of CVI and worsen genetic syndromes and birth defects. Some of these infections include encephalitis, meningitis, and cytomegalovirus (Lueck et al., 2019). Congenital brain malformations cannot be ignored because of numerous sources of poisoning and drug exposure that could exacerbate CVI, such as cocaine, carbon monoxide, sedating drugs, and many other chemicals that affect humans.
Literature Review
Signs and Symptoms of CVI
There are numerous symptoms and signs that have to be considered when addressing CVI. For example, Swift et al. (2008, p. 7) suggest that visual performance in children with CVI could be decidedly variable, with students being used to turning their head when reaching for objects. In addition, poor visual attention could be attributed to students with CVI due to their gaze behaviors and the overall difficulty linked to visual novelty. This can be explained by the existence of neurological issues resulting in complications affecting the children’s motor and cognitive performance (Swift et al., 2008). Even though students with CVI could have a preference for brighter colors, they might be willing to avoid the discomfort caused by light gaze fixation. It was also noted by Merabet et al. (2017) that the visual field could be restricted in students with CVI, leading them to peripheral field loss.
Assessment Methods
The wide range of health-related effects of CVI makes it crucial to implement as many varied assessment methods as possible in order to finalize diagnostic procedures and make the further treatment process more feasible. Evidence from clinical practice suggests that detailed knowledge on the subject of CVI in children can be attained with the help of several fundamental assessments: (a) interviews and patient history interpretation, (b) assessments (formal and informal) of functional vision and visual functions, (c) observation of behavior, (d) developmental and educational skill evaluation (Philip & Dutton, 2014). Additionally, it could be important to pay more attention to the physical environment and instructional guidelines. For instance, the efficacy of diagnostic teaching could be assessed after the intervention methods have been outlined and monitored for some time by the actors responsible for carrying out the intervention (Lehman, 2012). Results of all these assessments could be utilized later to modify interventions that perform the least efficaciously and do not align against learners’ expectations.
Curricular Adaptations
In the field of curricular adaptations, numerous changes had to be introduced due to the advent of CVI because of the need to include vision goals for students who are engaged in active learning environments. For example, one of the primary tasks for teachers could be to establish students’ CVI Range scores in order to design relevant materials and plan activities in advance (Swift et al., 2008). The insight into a child’s CVI Range could be helpful in terms of adapting the learning environment to the needs of every given student, depending on optimal distance, an appropriate number of visual targets, and preferred colors and visual fields. Nevertheless, curricular adaptations should remain in line with the focus of active learning in order to ensure that CVI learners are going to participate in the process (Watson et al., 2007). The increasing role of sensory input should be respected by teachers in order to pave the way for learning approaches that consider all sensory inputs with no discrimination. Consistent with Roman-Lantzy (2007), curricular adaptations for CVI should also consider latency, as both common learners and students with impairments should have enough time to plan and execute responses to the tasks offered by teachers.
Teaching Strategies
The range of strategies that could be utilized to support students with CVI is rather broad. The first element that has to be considered is the fact that teachers possess the capability to manage student behavior and predict certain actions (Lehman, 2012). Therefore, social (as per Bandura’s theory) and academic skills that children develop can be emphasized to hint at the weakest suits that should be addressed. A continuous process of positive reinforcement is going to help students recognize their strengths and capitalize on them while overcoming vision impairments with the help of responsible stakeholders. This is why encouragement from parents is another pillar of social and academic success attained by children with CVI. The behavior and appearance of such children should be managed carefully in order to shape their social development and grow them into respected human beings (Lueck et al., 2019). With personalized teaching strategies, it will become exceptionally easier for educators and parents to collaborate and enhance all types of skills possessed by children with CVI.
Teaching Interventions
In addition to teaching strategies, it can be essential to deploy particular interventions intended to help educators reach out to children with CVI. For instance, Swift et al. (2008, p. 10) suggest that some of the most effective interventions might be to utilize touch and vision at the same time while also capitalizing on high contrast and different movements. These effects could be achieved via the use of technology and a simplified learning environment with a vivid visual field. From appropriate lighting to response times, teachers should remain proactive in all areas of verbal and nonverbal communication with students with CVI (Swift et al., 2008, p. 10; Merabet et al., 2017). This means that tactile and verbal cues should be interconnected in order to function properly and aid teachers in employing all kinds of prompts in their practice successfully. Based on preceding experience, teachers could avoid failures while also paying more attention to the psychological and physiological state of their students.
Dorsal and Ventral Streams
The dorsal stream relates to how the course of spatial processing is carried out by the brain to transfer the information from the occipital cortex toward posterior parietal cortical areas. The dorsal stream is also known as the “where” of vision. Conversely, the ventral stream represents the “what” of vision because it projects from the occipital cortex to the temporal lobe (Ries et al., 2019). The functions associated with the ventral stream are much more often associated with impairments touching upon human development and functioning. Thus, significant alterations in either of the streams could diminish visual attention and cause children to develop photophobia (Ries et al., 2019). Abnormal dorsal and ventral streams could also predict impairments in visuospatial processing, leading to developmental and learning challenges.
Supporting a Student with CVI
The primary task that teachers would have to complete to support students with CVI is to establish complex treatment goals that require multidisciplinary methods to achieve them. The rationale behind this approach is the need to minimize the competitive demand and help the child develop skills within a friendlier educational environment (Lueck et al., 2019). Visual training should be at the forefront of the child’s activity list in order to have the teacher provide all the support they can to make the learning process purposeful and stress-free. For example, Philip and Dutton (2014) suggested engaging in visual training and providing students with postural support upon request.
This task would require teachers to complete the complex preset objectives together with the child, meaning that postural support would save the child’s energy and help them target visual tasks instead. Any other requirement that could be too resource-intensive should be moved to the list of secondary tasks because interventions have to provide students with a minimum amount of distress (Merabet et al., 2017). In turn, the teacher would have to ensure that every student is comfortable with their sitting position, lighting, and room temperature prior to engaging in active learning.
Another important task that is crucial for supporting children with CVI is to have the teachers include the factor of physiological and psychological health in their educational plans. According to Philip and Dutton (2014), this is a fundamental principle of helping impaired children learn because an optimum alert level has to be the time when such students engage in the learning process. The responsibility of the teacher and the child’s family would be to observe the student during the day to determine the periods when they are most likely to display peak interest in engaging in various activities (Swift et al., 2008). By doing this, teachers are going to have a better understanding of when to schedule the most difficult tasks without frustrating the child. Students with impaired vision should go through predictable routines in order to achieve better personal and academic results (Lehman, 2012). Thus, the tendency of impaired students losing focus would be overrun, allowing teachers to switch between tasks at the right times to keep learners active and motivated.
Ultimately, it is not recommended to engage the multidisciplinary team at all times so that students with CVI might have a chance to work within an unrestrictive learning environment. It means that the highest levels of social and educational benefits are going to be achieved by means of teachers helping them to transfer their skills to new environments and disrupting the chains of concomitant neurological deficits (Merabet et al., 2017). Thus, a limited number of people being involved in impaired learning interventions might become an advantage in the long run. This is also true for environments where students with multiple sensory impairments have to learn, as they might remain rewarded inadequately after participating in all the activities. To overcome this issue, teachers will have to deploy active learning to launch intrinsic motivation and only select the stimuli that can be deemed as preferred by visually impaired learners (Watson et al., 2007). Nonetheless, the majority of reinforcers should be natural in order to improve the guided learning experience for children with CVI.
Conclusion
Overall, it can be concluded that students with CVI represent a problematic population that has to be addressed in order to achieve educational and assessment equity. Student behaviors have to be managed to aid teachers in terms of creating a friendlier learning environment where new skills are going to be acquired easier. Thus, interdisciplinary teams could be formed to satisfy teachers’ and students’ needs on both short-term and long-term scales. For the current research, it means that there are numerous opportunities for care and education providers to reach out to the target population and ensure that their exposure to CVI is going to become less painful. A greater level of understanding between teachers and students with visual impairments could be achieved through the interface of consistent interviews intended to disclose more vital information regarding targeted children. After having the opportunity to observe behaviors and interpret children’s interviews, teachers might be able to appeal to students’ capabilities by engaging them in active learning and more consistent skill evaluations. Without paying attention to the skills and needs of students with CVI, teachers are going to have a hard time adapting to impaired learners.
Nevertheless, in order to reap all the benefits and take advantage of the multidisciplinary approach, teachers will have to spend more time assessing students with CVI because their interpretations and learning abilities differ drastically. This means that a cohesive picture of a student with certain visual impairments should be created prior to the implementation of new learning strategies or theories. Speaking of the Social Cognitive Learning theory, its importance also has to be acknowledged by educators who want to master the skill of sensitive interpretation of one’s behaviors and needs. The culmination of the current findings is the idea that an effective instructional program would have to be handcrafted in order to appeal to the holistic principles of teaching and unique needs of students with CVI. This is why an interdisciplinary approach can be considered the most effective means of addressing visual impairments and helping children advance both personally and academically. Overall, students with CVI represent a minority population of children who need to be assessed and observed more often than any other category of students. This is why constant support should be provided in an attempt to bring equity and knowledge.
References
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Roman-Lantzy, C. (2007). Cortical visual impairment: An approach to assessment and intervention. American Foundation for the Blind.
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