Slide 1
Lighting for Children with Immature Visual Systems and those with Cortical/Cerebral Visual Impairment
Photo, Alt = Cute little girl with ponytail and heavy black rim glasses.
Slide 2
This presentation belongs to APH.
If you’d like to borrow this presentation, APH will be glad to loan it to you provided that you:
• Do not change it.
• Give APH proper attribution
• Let APH know what you plan to use it for. (We like to keep records. We’re research basedJ.)
• Call Elaine Kitchel at (800) 223-1839 ext: 313 to arrange it.
Slide 3
When it comes to learners who are very young or who have CVI, and how they are affected by light, we don’t know much. But we do know some things.
Photo, Alt = cute three-year-old trying to walk in father’s shoes.
Slide 4
We know that some learners who have CVI or are very young,
• Experience light in ways different from adults with typical vision
• Experience light in ways different from learners the same age
• Experience light in ways different from youth and adults with the same vision diagnosis
• Sometimes experience light in a synesthetic way.
We believe that for some children light often seems to throb or pulsate, fade and unfade, or make objects shimmer or often disappear.
explain “synethesia” – the pairing with one sensory experience with another. One example would be seeing colors when you hear music. Hearing music when you turn on the water. Seeing numerals as having specific colors.
Slide 5
• Experience confusion and avoidance in the presence of blue light
• Experience confusion and avoidance in the presence of very bright light
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What are some of the ways this is manifest?
• Child turns away from light
• Child shows signs of stress (squint, yawn, close eyes, rapid blink, waves arms, cries)
• Child becomes non-responsive
• Child respirations change
• Child returns to his/her normal responsiveness when the offending light source is removed
Photo, Alt = Child in teacher’s arms is resisting the activity the teacher is doing with her.
References available upon request.
Slide 7
Research has shown:
• Studies that involved children with cortical dysfunction showed that certain wavelengths of light relieved problems of characters that shift or move during reading activities.
• The same studies showed dysfunction could be induced by certain wavelengths of light presented during reading activities. Can we extrapolate to learners with CVI?
Slide 8
• Some students, especially those with CVI often become overwhelmed by certain colors of light or specific intensities of light, or combinations of each. We have observed this when students turn away from a lighted task.
Photo, Alt= Child turns away from his task, puts hand over part of his face.
Colors are spoken of in terms of wavelength.
Intensity of light is spoken of in terms of lux.
Slide 9
• Some students are not as bothered by the light or its color until they have to perform a reading task, or use small muscles in a task. Then, some become overwhelmed. Why?
Photo, Alt = Young boy is grasping pencil in his fist, gritting his teeth, and holding his head as if he is very angry or frustrated.
Slide 10
We must learn a little about the physics of light
Chart, Alt = Chart of energy waves, somewhat incomplete. Shows x-rays as fastest waves, followed by ultraviolet, followed by the visible spectrum (blue, green, red), followed by infrared radiation, followed by microwaves, followed by radio waves being the longest we know of.
Slide 11
We can see only 3 colors of light.
Chart, Alt= Simple chart shows red light waves as slower than green ones, and green ones slower than blue ones.
Slide 12
But you say you can see more than 3 colors! You can see more than 16 mil.
This is explained by colors overlapping and how much each hue is saturated when they are mixed.
Slide 13
In Addition, Science and Observation have shown:
• Blue light makes the visual system work 2,000,000,000,000 (2 trillion) times harder than red light and billions of times harder than green light.
• Ultraviolet makes it work even harder, processing billions more waves per second, even though we can’t see it.
• Learners with CVI most often prefer red and yellow toys, tools, paper, crayons. Why do you suppose that is? Are they selecting by instinct?
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Does he choose based upon what makes him comfortable?
Photo, Alt = Male infant plays with a red and yellow toy.
Slide 15
Photo, Alt= Little girl playing with colored transparent cups on a light box.
Slide 16
In my practice, I have tested:
• Visually impaired learners 12 and younger, most were found to be very sensitive to blue and ultraviolet light, some more than others.
• Children with CVI and children with very immature neurological and visual systems worked more efficiently for longer under red, yellow, and sometimes green light. They also preferred working under red or yellow light, and maintained their preferences over the period I worked with them.
Slide 17
Follow up, 10-12 years after testing has shown:
• All but two of the 94 that preferred to work in red light, still do.
• Of the twenty three that preferred yellow light, all still do.
• Of the 10 that preferred green light, 7 now prefer yellow. The other 3 are migraine sufferers.
Migraine sufferers have been show to be able to avoid migraine and to have better eye comfort in the presence of prevailing green light.
Slide 18
Three primary ways you can help:
• Eliminate blue light from the learning environment. This means changing the color of the walls and floors if necessary.
• Add red light to the learning environment.
• Allow the child to show you his/her light preference through his/her toy choices and alternatives presented during functional vision assessment.
Photo, Alt = Red stuffed toy
Slide 19
Before you add color to the environment of a learner with CVI or an immature visual system
• Make sure the learner is rested, well-fed, calm and ready to learn.
• Ascertain what his/her favorite color is
• Use that color as a guide for what color works for your learner during educational activities
• Situate your learner in a place where the light is dimmable.
• Be prepared to switch from overhead light to flashlight or headlamp.
Slide 20
So let’s say you are a little child with CVI… Like Lindabelle Saylor
Photo, Alt tag= little 5 year old in flowered hat and sunglasses. Lindabelle has von Willebrandt’s syndrome as well as CVI. She is very sensitive to light.
Slide 21
You are easily overwhelmed by bright light, and you become downright wild in the presence of blue light.
• The people who educate you are not aware of lighting limitations for children with CVI. They put you here.
Lindabelle says she feels as if she is “crazy” when blue light shines on her.
Photo, Alt tag= Sensory stimulation room lit with mostly blue lights, a few yellow light curtains and fiber optic features and a blue fiber optic waterfall.
Very little pink light in the room except as projected asterisms on the walls.
Slide 22
Or worse, here:
Lindabelle has had seizures induced by exposure to black light.
Photo, Alt tag = This sensory stimulation room is lit completely with black light, also known as ultraviolet or Wood’s light. It is very dangerous for people with CVI for two reasons. 1) retinal cell death occurs in fewer than 4 minutes. 2) Blue and ultraviolet light makes learners with CVI cringe and withdraw after very few seconds in these conditions.
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Can learners like Lindabelle benefit from sensory stimulation rooms at all?
• Even appropriately lit sensory rooms usually have too much overall stimulation going on.
Slide 24
Yes, if we focus on one appropriately colored thing at a time, and rest in between.
Slide 25
Darn Good Sensory Room
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What if you’re a little guy with brain damage and you have a bedroom like this,
As a teacher who knows that blue, even reflected blue works the visual system 2 trillion times harder than necessary what changes would you recommend?
1) Color of ceiling?
2) Color of walls?
3) Color of bed comforter?
4) Color of light?
Slide 27
Some principles to remember are:
• Simplify
• Remove blue
• Use black, grey and white
• Use yellows, reds for accent
• One large geometric
• Provide hide-away place.
Photo, Alt = Cream-colored room with yellow shelves, yellow rug, yellow bed coverings, yellow and taupe curtains on the hideaway which is under the top bunk where the bottom bunk would ordinarily be. Floor of ash planks.
Slide 28
Nursery
This is an almost perfect nursery for a child with CVI.
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Variations
Photo, Alt = Boys bedroom with very light walls and cabinetry. There is a large, round red rug, yellow and red bed coverings, and some yellow shelf backing that is painted yellow.
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One dominant geometric pattern
Photo, Alt = Yellow child’s room with white and grey cabinets; orange, yellow, pink, red striped bed coverings; large red rug with 9 big white dots on it.
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Or maybe black with just a little color
Photo, alt = Bedroom with black walls with white stars painted on them. There is a bed covering with large planets, primarily yellow ones, which covers the bed. Floor is white. Drawers are white and yellow.
Slide 32
Things you can do to eliminate blue light from the learning environment:
• Replace cool white, full spectrum, daylight tubes and lights with warm white (2700K)
• Provide children with filters to wear
Photo 1, Alt = pair of pink UV filters
Photo 2, Alt = three boys, two wear orange UV filters, one wears yellow UV filters
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Provide hats to reduce light in the eyes.
Photo, Alt = little boy, in army canvas hat.
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• Provide dim light learning environments.
Photo, Alt = Two Little girls are playing with plastic rings on a light table in a dim room.
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• Provide tinted windows.
Photo, Alt = two men sitting in large room with floor-to-ceiling tinted windows
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• Limit light experiences to small scale ones that you can control.
Photo, Alt = Little child lying on his/her side, looking at light box with design on it.
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• Provide walls in warm colors.
Photo, Alt = Grey and white chickadee, with palette of colors in the orange, peach, yellow, pink, tan ranges.
Slide 38
You want a classroom like this.
Photo, Alt = Classroom lit with soft, warm, slightly pink light, with a teacher and two little girls working there.
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Not like this:
Photo, Alt = Typical classroom lit with banks of cool white tubes. These tubes give a bluish tint to the whole room.
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It takes time to implement these changes. So let’s get started!
We owe it to our students.
Photo, Alt = Photo of my niece, Adryanna, who has Staargardt’s disease.
Slide 41
Now I must go to get ready for my real job!
Photo, Alt = Chubby ballerina in arabesque pose.
Slide 42
Resources
Bergmanson, J. P. (1993). Ultraviolet radiation damage to the corneal endothelium? Ophthalmology, 100(4), 442-443.
Bradnam, M.S., Montgomery, D. M., Moseley, H., & Dutton, G. N. (1995). Quantitative assessment of the blue-light hazard during indirect ophthalmoscopy and the increase in the “safe” operating period achieved using a yellow lens. Opthamology, 102(5), 799-804.
Chen, E. (1993). Inhibition of cytochrome oxidase and blue-light damage in rat retina. Graefe’s Archive for Clinical and Experimental Ophthalmology, 231(7), 416-423.
Chou, B. R. (n.d.). Ocular health and the atmospheric environment. Ontario, Canada: University of Waterloo, School of Optometry.
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Resources
• Coutts, L. Cooper, C.E., Elwell, C.E., & Wilkins, A.J. (2012). Time course of the haemodynamic response to visual stimulation in migraine, measured using near-infrared spectroscopy.Cephalalgia 32(8) 621–629.
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• Creech, L. L., & Mayer, J. A. (1997). Ultraviolet radiation exposure in children: a review of measurement strategies. Annals of Behavioral Medicine, 19(4), 399-407.
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• Fedorovich, I. B., Zak, P. P., & Ostrovskii, M. A. (1994). Enhanced transmission of UV light by human eye lens in early childhood and age-related yellowing of the lens. Doklady Biological Sciences, 336(1), 204-206.
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• Ham, W. T., Jr. (1983). Ocular hazards of light sources: review of current knowledge. Journal of Occupational Medicine, 25(2), 101-103.
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• Ham, W. T., Jr., Ruffolo, J. J., Jr., Mueller, H. A., & Guerry, D., III. (1980). The nature of retinal radiation damage: dependence on wavelength, power level and exposure time; the quantitative dimensions of intense light damage as obtained from animal studies, Section II. Applied Research, 20, 1005-1111.
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Resources
• Hightower, K. R. (1995). The role of the lens epithelium in development of UV cataract. Current Eye Research, 14, 71-78.
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• Hao, W., & Fong, H. K. (1996). Blue and ultraviolet light-absorbing opsin from the retinal pigment epithelium. Biochemistry, 35, 6251-6256.
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• Knowlton, M. (1986). Ultraviolet light: some considerations for vision stimulation. Education of the Visually Handicapped, 17(4), 147-153.
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• Organisciak, D. T., Darrow, R. M., Barsalou, L., Darrow, R. A., Kutty, R. K., Kutty, G., & Wiggert, B. (1998). Light history and age-related changes in retinal light damage. Investigative Ophthalmology & Visual Science, 39(7), 1107-1116.
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• Pautler, E. L., Morita, M., & Beezley, D. (1989). Reversible and irreversible blue light damage to the isolated, mammalian pigment epithelium. Proceedings of the International Symposium on Retinal Degeneration (pp. 555-567). New York: Liss.
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Resources
• Rapp, L. M. & Smith, S. C. (1992). Morphologic comparisons between rhodopsin-mediated and short-wavelength classes of retinal light damage. Investigative Ophthalmology & Visual Science,33, 3367-3377.