New  York  Deaf-­Blind  Collaborative

Student-­‐Centered  AAC  for  Learners  with  Cortical  Visual  Impairment  (CVI):  Assessment,  Design,  and  Implementation  

Chris  Russell,  TVI,  MS.Ed.Project  Coordinator,  NYDBCchristopher.russell@qc.cuny.edu

Cortical  Visual  Impairment

¡ Information  Based  on:§ Roman-­‐Lantzy,  C.  (2018)  Cortical  visual  impairment:  An  approach  to  assessment  and  intervention  (2nd Ed.).  New  York:  AFB  Press  

¡ Photography  credit:§ SLP-­‐CCCs:  Megan  Mogan,  Kaitlin  Ahl,  Lori  Robinson§ Emma  Nelson,  Vermont  Sensory  Access  Project§ Video  credit:  Kaitlin  Ahl,  SLP-­‐CCC

What  is  Cortical  Visual  Impairment?

¡ Vision  loss  due  to  damage  or  malformation  in  the  brain  that  interferes  with  the  child’s  ability  to  understand  visual  information  coming  from  the  eyes

¡ CVI  is  the  leading  cause  of  visual  impairment  in  young  children  living  in  the  Western  Hemisphere

(Good,  et  al.,  2001;  Roman,  2018)

Population  Overview

¡ 2016  National  DB  Child  Count§ 10,749  age  0-­‐21  DB▪ 2808  diagnosed  CVI  out  of  9,635  (29.1%)▪ 1331  unknown  out  of  9,635  (13.8%)

§ Significant  variability  from  state  to  state▪ AZ:  128/211  CVI  (60.7%),  0  unknown▪ AL:  6/178  CVI  (3.7%),  1  unknown▪ PA:  125/453  (27.6%),  0  unknown▪ TX:  206/685  (30.1%),  92  unknown

http://nationaldb.org/reports/national-­child-­count-­2016

Why  is  it  important  to  identify  and  assess?

¡ Specific  interventions  to  IMPROVE visual  functioning§ Different  approaches  depending  on  where  the  student  falls  on  the  RANGE  of  visual  functioning

§ Guided  by  Phase,  adapted  by  Characteristic

Intervention  is  a  collaborative  TEAM  EFFORT

PHASE  I PHASE  II PHASE  III

Sensory  Access• CVI  Phase  and    

Characteristics• Preferred  learning  

channels

Communication  Level  Access

• Presymbolic/Symbolic• Prelinguistic/Linguistic

A  Balanced  Communication  Plan

• Multi-­sensory  access• Universal  Design

• Model  TOTAL  COMMUNICATION    • Provide  a  robust  AAC  program  receptively

Sensory  Access  for  CVI:  Design  and  Implementation

Material  ConsiderationsWhat  does  the  AAC  system  look/feel  

like?

Environmental  ConsiderationsHow  can  the  setting  be  modified?

Presentation  of  AACHow  can  the  learner  best  access  the  AAC  

system/mode?

Design

Implem

entatio

n

Phase  I  Intervention:  Most  Characteristics

¡ NO  visual  processing  of  2-­‐D

¡ Maximize  visual  access  to  modalities  but  don’t  expect  visual  fixation  

¡ Tactile  components  are  critical  

Goal:  Stabilize  visual  functioning

Looking  is  a  goal  in  itself

High  level  of  environmental  control

Color Complexity Light

Tactile  &/or  auditory  access  with  visual  adaptations

Phase  II  Intervention

Goal:  Integrate  Vision  and  Function

What  needs  to  be  adapted  visually  in  order  to  elicit  and  sustain  visual  attention  at  targeted  points  in  a  routine?

• Able  to  use  vision  in  activities,  with  adaptations  and  opportunities

• Early  à Late  Phase  II• Level  of  visual  adaptation  needed

• 2D  emergingCVI  Schedule  &  Planning  Tools

Color Complexity

Visual  Novelty Visual  Fields

Light

Iconicity  – 3D,  2DObjects,  partial  objectsPhotos,  line  drawings

Phase  III  Intervention

Salient feature  -­‐ what  specific  part  of  the  symbol  gives  it  unique  meaning?

“Critical  component”  (Bent  &  Buckley,  2013)

Goal:  Vision  for  learning

• Demonstrate  visual  curiosity

• Can  process  2-­‐D• Need  

adaptations  to  support  learning  and  visual  vocabulary

Colored  Keyguardhttp://www.laseredpics.biz

Beware  of  glare!

Sight  Words  -­‐ Bubbling  with  Color

Don’t  limit  the  number  of  cells  on  a  device;  Limit  the  number  of  cells  used  in  the  array

Environmental  Considerations  &  Presentation

Complexity

Light Color

Visual  Fields

Distance

Movement Visual  Novelty

Accessible  Modes  of  Communication

PresymbolicPre-­‐intentional,  

Unconventional,  Conventional

Emerging  Symbolic  (Concrete)

AbstractWords  &  Language

Total  Communication

Approach  Framework

Shared  Forms

Aided  Language  Stimulation

PrelinguisticMilieu  Teaching

Augmentative  and  AlternativeCommunication  (AAC)  includes  allforms  of  communication  (other  thanoral  speech)  that  are  used  to  expressthoughts,  needs,  wants,  and  ideas.We  all use  AAC  when  we  make  facialexpressions  or  gestures,  use  symbolsor  pictures,  or  write.            

(ASHA,  2016)

Example:  (Late)  Phase  II,  Emerging  Symbolic  

• What  are  the  CVI  adaptations?• What  are  the  communication  modifications?

CVI:• Partial  objects  (not  yet  2-­‐D)• Black  backdrop  (visual  

clutter)• Red  rectangle  highlight• Red  tape  on  rim  of  finished  

box

Communication  – Levels  and  Modes:

• Tangible  symbols• Visual  sign  with  tactile  

modifications• Constant  contact/tactile  support

• Speech  /  audition• Prompts  /  wait  time

Systems  that  grow  with  the  child

¡ From  3D  to  2D¡ From  Pre-­‐symbolic  to  Symbolic¡ Developing  complex  language

Visual  &  Tactile  Modifications  to  Sign

Phase  I:  • Tactile  Sign  /  Hand-­‐Under-­‐Hand  Modeling

All  Phases:  Consider  background  complexity  (clothing,  backdrop)

Phase  II  (Early  à Late):• Visual  sign  at  near,  tactile  supports  still  needed• Consider  visual  field  preferences  -­‐ tracking• Reduced  complexity  of  backdrop  is  critical• Allow  for  “looking  away”  in  visually  guided  reach

Phase  III:  • Visual  sign  may  be  accessible  at  increased  

distance• Tactile  modifications  still  may  be  needed  in  

complex  or  novel  environments

Accessible  Back-­‐channeling:VisualTactileAuditory

Combination/TOTAL  COMM.

Example:  Emergent  2D  Literacy,  Tactile  Sign  Modification

“In  addition  to  technology,  ...early  communication  programs  may  be  maximally  effective  when  participants  are  taught  to  combine  technology  with  unaided communication  responses.”    

-­‐ Brady  &  Bashinski,  2008

Remember  to  use  MULTIPLE  MODES!

Questions?

References

American  Speech-­‐Language-­‐Hearing  Association  Augmentative  and  Alternative  Communication  (AAC).  Retrieved  from:  http://www.asha.org/public/speech/disorders/AAC/

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Bent,  D.,  &  Buckley,  W.  (2013).  Visual  considerations  for  choosing  picture  communication  symbols.  Presented  at  Getting  in  Touch  with  Literacy  Conference  December  2013,  Providence,  RI.

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New  York  Deaf-­Blind  Collaborative

NYDBC  StaffSusanne  Morrow,  Project  DirectorChris  Russell,  Project  CoordinatorSuzanne  Chen,  Family  Outreach  CoordinatorEneida  Lamberty,  Project  AssistantDr.  Patricia  Rachal,  Principal  Investigator

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