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Combining Visual and Auditory Cortical / Cerebral

Scanning for Children with CVI Visual Impairment
and Complex Communication
Needs • Visual challenges caused by
damage to the brain
Linda Burkhart & Gayle Porter
www.LBurkhart.com • Vision skills fluctuate -
often inconsistent and
changeable - especially in
Gayle  Porter  is  the  developer  of  PODD  and  receives  royal6es  from  sales  of    
PODD  template  resources.    Gayle  Porter  and  Linda  Burkhart  are  paid   relation to environmental
honorariums  for  delivery  of  PODD  and  other  trainings.    Both  Linda  and  Gayle  
consulted  with  Mayer-­‐Johnson  to  advise  them  in  the  development  of  high   conditions
contrast  PCS  on  a  voluntary  basis.  

• A vision specialist in conjunction with a

• CVI May or May Not specially trained pediatric ophthalmologist
and the family, should work together to
Occur with Ocular determine the presence of CVI
Disabilities

•CVI Range -
• CVI Frequently Screening Tool
Occurs with Other (Roman-Lantzy)
Neurological Damage • Functional Vision
Assessment

CVI Occurs within a Wide Range of

CVI is a Continuum (Range) Cognitive Abilities and Cognitive
of Characteristic that Must Potential
be Evaluated Individually for
Each Child

Different parts of the brain

ISAAC 2012 Linda Burkhart Gayle Porter

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• Sometimes, the neural pathways Strategies and Accommodations

can be rewired around for Cortical Visual Impairment
damaged areas of the brain to and
make new cortical connections AAC

Effective Intervention
Strategies Dr. Christine Roman-Lantzy
• Customized environmental adaptations to Characteristics of
the child s natural routine
Children with Cortical
• Modifications to presentation of materials Visual Impairment

in every day environments to support the
best visual functioning www.afb.org/store



• Not vision therapy
www.aph.org/cvi

Difficulty with Visual Novelty •Communication Displays should make use of

familiar vocabulary location, pattern and
sequence
• Lack of visual curiosity

• Brain is more likely to have built

neurological connections for recognition for
familiar items

• Children with CVI do see better at home

and in familiar settings

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PODD Communication Books Provide

Consistency of Presentation
•Communication
Displays should
make use of
familiar
vocabulary
location,
pattern and
sequence

Difficulty with Distance Pull-Off Symbols

Viewing
• Child may view items at close distance to
reduce complexity
• Child may have difficulty coordinating eyes
for depth perception

Bring Pictures Close then

Move Back for Focus

Presentation of a column of
Pull-Off Columns symbols at a time
• Visually simpler for the child

• More complex for the partner

• May take more time

• Results in a much thicker book

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Complexity
Issues Reduce
of Complexity
Complexity One of the hardest
characteristics to
resolve, but one that
can often be dealt
with by type and
presentation of
materials

Complexity Visual complexity can

• Visual complexity compounds visual impact what the child can
difficulties
process and understand
Complexity
• Other sensory input can compound visual
complexity

Visual complexity & AAC Visual Complexity of

Symbols
• Number of items
on the display

• Spacing
(crowding) of
items on the
display

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Problems with Photographs Black lines in Symbols

Complexity - Multiple Colors and Details Complexity - Multiple Colors and Details

High-lighted backgrounds were a good High-lighted background may not be as

alternative for activity specific displays useful for other vocabulary
to highlight parts of speech and break organizational systems
up a larger activity specific display

(Goossens , Crain & Elder, 1992)

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Child with CVI may be more New Mayer-Johnson PCS

attracted to the color of the High Contrast Symbols
background than the shape of the
symbol

Guidelines for Creating and Reduce visual complexity of

Modifying Symbols for CVI each symbol
Increase visual contrast
•Black background with light • Less number of colors - try to keep to one
or bright contrasting colors or two colors per symbol
• Red and Yellow are good for • Simpler forms/lines
many children with CVI • Use of color to support discrimination
• Other bright colors between similar shapes

• Simple solid shapes

• Possibly bold the main element instead of
using an arrow to show emphasis

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Reduce visual complexity of Discrimination between

each symbol similar symbols

• Use of varied solid shape

for similar symbols – not
just varied internal detail
• Use of color to support
• Use of egghead people instead of adding discrimination between
hair similar shapes (ie: similar
• Fewer internal lines of detail the better shape heads maybe colored
• Solid shapes rather than lines different)

Additional Considerations
Color Can Assist with
Discrimination of Symbols • One option per word
such as play - not all
the variations
• Still need large number
of vocabulary items for
specificity
• When possible -
similarities to existing
symbols is desirable

Color May Assist with Alternative auditory / visual presentation

Discrimination of Symbols PODDs

• High contrast – direct access

• Auditory plus visual scanning

–Regular symbols
–High-contrast symbols

• Auditory scanning

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Social speech versus

Auditory plus Visual Scanning
operational speech

• Partner s speech is part of the

selection set

• Need to help partners learn to use

operational speech for the auditory
scan
–Scanning is not a series of questions

Scanning operational speech

Scan vs. Series of Questions (like the device would scan)
something s Is something
wrong
wrong?

want Do you want

something
something?

Do you want
go
to go
somewhere

somewhere?

Consider Starting With a One Per

Page PODD
• Include
instructions to
help partners use
operational
speech in the scan

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Have a Pull-Off Companion Version for

Reduce visual Direct Modeling
complexity for child
-Some of the Time
Sequentially present
one symbol at a time

Assist partner to
learn to perform
auditory plus visual
scanning

Decide if some items will just be Column-item visual plus auditory scanning
presented auditorally in a list format

Visual & Auditory Combination

Flap -
More to Say
Pull Off Symbols or Columns
Once the child has
• Visually simpler for the child selected a word from the
scan - that does not
• More complex for the partner branch, the
communication partner
• May take more time scans the flap. This allows
the child to combine
multiple words to create
• Results in a much thicker book
his message.

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• Page #1 is branches
One / a few at a time auditory plus visual
scanning • Link to chat words page 2

• Is partial, transient and temporal

• Cannot look around whole page

opening and see what other words
are on this page

• Need to hear/see every option before

deciding if can change page
–Unless learned the page

When Symbols are Presented One or a When Symbols are Presented One or a
Few at a Time: Few at a Time:
• Turn the page Last (or first and last) • Turn the page Last (or first and last)

Vocabulary with possible semantic associations are

grouped together in columns to help manage the Increased use of subcategories
difficulties of transience

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Increased use of lists

• Auditory scan some predictably • Auditory scan predictably associated

associated vocabulary vocabulary
» Sentence starters
» Sentence starters
» Topic action words
» Topic descriptions words

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Auditory plus visual scan with some just auditory

Auditory plus visual scan with some just auditory

Auditory plus visual scan with some just auditory

Auditory only
partner-assisted scanning

Auditory Only Page Layout

Auditory scanning
• More portable/manageable book
– Less partner skill / time / effort presenting
• Recognition of spoken words symbols one at a time
– ? Time required to look
• Temporal presentation • No Point of Focus for Joint Attention

• Limited selection set presented at • Spaces between groups of words -

one time (auditory memory) instead of columns
• One page general interaction / early
• Selection set is transient functions

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General interaction / early functions

When to use what?

• Primary purpose is to support
communication throughout the day
• Some vision strategies can be used some
of the time, but for practicality reasons,
you may not be using them all the time.
• Emphasis should be on frequent
communicative interactions with supports
for vision use when reasonable
• Don t hold the child back in the area of
communication development because of
vision deficits

Remember
The primary purpose of an AAC system is to
enable

AARCH
the child to most effectively meet their
communication requirements as
– intelligibly
– specifically Communication
– efficiently
– independently • Autonomy
– in as socially valued a manner • Accessibility
– as possible • Requirements
To understand others and to be • Competence
understood. • Habits – all the time

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