Kendra Lockwood 2013

CVI Range Narrative Report

Personal Data:
Name: / Date of Birth:
School: / Age: 6
Grade: Kdg / Assessment Date:
District: / Assessed by:
Parent/Guardian: / Address:
City, State, Zip: / Phone:

Referral and Review of Records

xxxx was referred for a Functional Vision and Learning Media Assessment (FVLMA) as part of a three year re-evaluation process due to vision concerns in the classroom. xxxxx has been served under Developmental Delay eligibility but the district is re-evaluating early in order to develop a better plan to meet her needs.

xxxxx has a visual diagnosis of alternating esotropia and secondary to meningitis, high fever, and stroke at age 11 months. She is currently undergoing patching therapy in the evenings at home. Her mother said they are to alternate patching each eye for 20 minutes at a time and that Kendra is very easily frustrated and angered by it. xxxx wears prescriptive lenses for myopia and astigmatism. Dr. xxxxx indicated vision loss due to stroke but the term CVI was not used.

xxxxx was assessed using tradition FVLMA materials but it appeared she was exhibiting characteristics of Cortical Visual Impairment (CVI) so she was also assessed using the Roman CVI Rating Scale. The Roman CVI Rating Scale is based on a set of observable characteristics common to all students with CVI. The rating scale examines the child’s visual behaviors to determine the current level of functioning and helps design interventions to improve functioning.

Parent Information

xxxxxxx, Kendra’s mother completed the parent interview. Ms. xxxxxxx said that xxxxxx lost her vision due to a stroke but the doctors told her she might get some of it back and she has, however she hasn’t noticed a significant change in a long time.

Ms. xxxxxx stated that xxxxxx is not very interested in television but when she does watch she gets very close. She also holds books very close to her face. She said that xxxxx is able to follow simple one step directions such as locating an item but only if the object is obviously out in the open. She will not search extensively and doesn’t see things partially covered. Ms. x said that xx most enjoys playing make believe with her dolls and treats them like they are real.

Ms. xxxxx felt that Kendra enjoyed being with people and loved to go places such as shopping. She said xxxxx would recognize the sign to McDonalds or Taco Bell but not to shopping stores without prompts. Ms. xxx said that xxxx often doesn’t appear to make eye contact and seems like she is looking past people. She also stated that xxxx appears to prefer very familiar items over new things and if given the choice would look at the familiar item first, then maybe the novel one. She said that xxxx does not seem to like any particular color, except maybe pink. Ms. xxxx said that xxx can usually identify the colors of crayons when asked but doesn’t pick a favorite.

Ms. xxxxx described xxxxx as easily frustrated and easy to anger. She said xxxxx has a low tolerance for things changing or not going her way, and will get angry quickly.

Teacher Information

xxxxx’s kindergarten teacher, Mrs. xxxx, stated that xxxx is well behind her peers in every subject and struggles to follow along in the regular classroom. She said that xxxx gets along well with her peers but it is not unusual for her to play alone on the playground. Mrs. xxxx noted that xxxx does most of her classwork in the special education resource room and not with her kindergarten class.

Mrs. xxxx, xxxxx’s special education teacher, stated xxxx was behind in her room and had difficulty coloring and tracing as well as difficulties paying attention. She noted that xxxxseems to be more alert in the mornings and has a good attitude and wants to learn. Mrs. Xxxx said Kendra enjoys playing school with a few other students and attends best to other people in the room over objects.

Mr. xxxx, the paraprofessional in Mrs. xxxx’s room, noted that xxxx appears to see better when standing and that she attends better to 3-D objects than pictures and likes using manipulatives. He described math and counting as a relative strength for xxxx and language based activities such as reading and writing as weaknesses. He said that xxxx needs extra time to settle down after transitions in order to be able to focus and attend.

Assessment Instruments, Materials, and Strategies

School environment observations
Structured assessment
LEA Near Acuity Test
Feinbloom Distance Acuity Test
Parent, Teacher, and Student Interview
Review of Records
Natural and Teacher Made Materials / Skills checklists/inventories
·  J.Johns Reading Inventory
·  Roman CVI Rating Scales

Medical History Information:

Eye Care Specialist
MD – Ophthalmologist OD – Optometrist / Eye Care Specialist / Functional Vision
Name: / Dr. OD
Date:

2.  Visual condition: Alternating esotropia, myopia and "vision loss due to stroke"

3.  Age of onset: birth

4.  Stability of visual condition: Stable Deteriorating Improving Uncertain

5.  Acuity (As reported by Dr. 2012 and Dr. 2013)

Distance / Near
Without Correction / With Correction / With Low Vision Device / Without Correction / With
Correction / With Low
Vision Device
OD: UTT / OD: / OD: / OD: / OD: / OD:
OS: UTT / OS: / OS: / OS: / OS: / OS:
OU: UTT / OU: / OU: / OU: / OU: / OU:

OD = Right Eye OS = Left Eye OU = Both Eyes

6.  Visual fields: not tested

Physical appearance and eye movement:

xxxxx’s eyes were clear with small minimally reactive pupils and a delayed blink reflex and a right intermittent esotropia.

·  Eye Preference: left

·  Hand Preference: right

·  Tracking: able to track a 1 inch unlit target in all directions

Informal Acuity:

Distance- xxxxx was able to read the 12m line of the Feinbloom distance acuity chart at 10 feet which as an approximate Snellen equivalent of 20/100.

Near- xxxxx was able to read 20/80 of the LEA symbols near vision chart at 12 inches; she preferred the much bigger symbols of the 20/200 line and had to be coaxed into cooperating with the smaller ones.

Color Discrimination:

xxxxx identified 100% of the color plates correctly but struggled and seemed unsure with the red/brown combinations.

Contrast Sensitivity:

xxxxxx was only able to read the first three of the LEA numbers contrast sensitivity cards at 12 inches.

Confrontation Functional Peripheral Fields:

xxxxx was unable to fully comply with the confrontational field testing. She did not understand the directions, but it appeared that she did best with her left peripheral field.

Observations of functioning in near (up to 16”) visual tasks:

xxxxx was able to trace simple 1” numbers and color inside dark black simple drawings. She was unable to write her name without something to trace but she could spell it orally. When asked to write the letters without a sample, she wrote them out of order.

xxxxx demonstrated jerky or halting handwriting. The figure ground activities were very stressful for her and caused defiant behavior. Her ability to describe what she saw was hindered by her weak vocabulary development. If asked to find the item she could, but could not always name it.

Observations of functioning in intermediate (16” to 3’) and distance (3’ and beyond) visual tasks:

xxxxx was unable to sustain visual attention beyond 3-5 feet. She was able to point to large familiar objects in the environment such as the computer and a poster on the wall but could not describe them. She insisted on moving closer to items she was asked to view.

Use of Sensory Channels:

xxxx preferred to listen over using vision whenever possible. She also demonstrated good tactual skills, identifying basic shapes, several toys, coins, pencil, and fork using only her sense of touch. The only item she missed was a large screw, which she was unable to identify visually as well.

CVI Characteristics

Color Preference

Students with CVI often have strong attractions to objects of a specific color. Use of the preferred color may serve as a visual anchor or way to attract attention by highlighting the salient features of certain objects or words. xxxxxx liked strong colors but did not appear to have a particular preference. It may be beneficial to pick a color such as yellow or orange and consistently use it to highlight salient features during direct instruction.

Light Gazing and Non-purposeful Gaze

Students with CVI are often highly attracted to lights and may have difficulty redirecting attention to purposeful tasks. xxxxx sits with her back to the windows and was able to adapt to the various lighting in his environments throughout the day without it affecting attention. However, xxxxx did enjoy lighted toys and flashlights. Light may be beneficial to help sustain visual attention.

Need for Movement

Students with CVI often use movement or objects that have properties that give the impression of movement, such as reflective surfaces, in order to initiate or maintain visual attention. Sometimes they see better when they themselves are moving. Xxxx prefers to stand and tends to be quite fidgety. It may be that allowing her to stand and providing frequent opportunities for movement benefits her ability to attend. While the use of movement may be beneficial in gaining visual attention, it can also be a distraction as a student with CVI may be particularly alerted to the movements of others in the room. Providing a calm quiet work environment may assist maintaining attention to task.

Visual Field Preference

Students with CVI typically have distinct field preferences. Some children ignore completely stimuli presented in certain fields and attend to others. xxxxx appeared to attend best when items were presented initially on her left side and brought toward the middle. It is also common for students with CVI to have upper and lower field losses. Records indicated concerns over xxxxx’s “clumsiness” and inability to handle ball sports. These may be indicators that she does have discrepancies in her upper and lower fields.

Visual Latency

Latency is a delay in response between the time the target is presented and the time the student first notices it and begins to attend. Often latency is increased with novel objects or in complex environments. xxxxx’s latency was minimal in a small group with familiar materials. Allowing her to have time to hold real objects and providing simple clear two dimension images should reduce her latency.

Difficulty with Visual Novelty

The typical visual system is more responsive to a novel target than a familiar one. However, students with CVI often reject novelty and only attend best to simple familiar objects that are of a preferred color or pattern. xxxx’s mother agreed that xxxxx prefers items she has seen many times over novel ones. She will eventually look at a novel item but is not drawn to them like a typically developing child would be. Kendra may perform best when provided direct instruction on the salient features of new objects and images to facilitate both her ability to visually process the image as well as learn the vocabulary associated with it.

Difficulties with Visual Complexity

Visual complexity involves three parts: the patterned surface of the object, the visual environment (visual array) surrounding the object and total sensory environment. Children with CVI have difficulty with complexity because they become overwhelmed by the stimuli and become unable to process what they are seeing. They may appear to be highly near sighted because they get very close to things in order to screen out the extra visual clutter in order to process the image correctly. xxxxx demonstrated difficulty with visual clutter. When asked to find brightly colored beads and buttons on a black background, she was easily able to comply. When asked to complete the same task on increasingly more complex patterned surfaces she became unable to visually locate the items and simply felt around for whatever might be there. xxxxxx may benefit from providing visual material on a black background which has the effect of highlighting the item to be viewed. xxxx was unable to identify black and white line drawings. She could identify some simple colored pictures but did best with real objects. She should be provided real objects whenever possible for initial instruction. She will need direct instruction in the salient features of object in order to learn how to “see” 2 dimensional images.

Difficulty with Distance Viewing

Difficulties with distance are related to complexity. Students with CVI may appear nearsighted because they have a greater ability to control the level of complexity at near. Holding things close screen out background clutter that is distracting when looking in the distance. The less complex the background the greater distance at which the student may be able to visually attend. Currently xxxxx appears unable to sustain visual attention beyond 3-5 feet depending on the complexity of the environment. The more noise and movement in the environment the closer she will need to be to the visual target.

Atypical Visual Reflexes

Visual reflexes are often absent or latent in patients with CVI. There is no specific treatment but they tend to improve as the other CVI characteristics improve, giving and indicating of the overall level of CVI present. xxxxx demonstrated a delayed blink response to touch and threat.