Cortical Visual Impairment and AAC

After yet another opportunity to listen to Linda Burkhart (http://www.lburkhart.com/index.html) at ATIA, we've been all excited about our work with children who have cortical visual impairment. Cortical visual impairment is a condition which causes the child to have a decreased ability to respond to and interpret visual information (http://www.tsbvi.edu/Outreach/seehear/fall98/cortical.htm.) When we encounter those children who are not visually attentive, who don't watch television and don't attend to a communication device we start to consider adaptations that are success for children with cortical visual impairment. Although we can't diagnose this condition, we are finding that standard strategies for CVI are effective in improving many of our patients' attention to and use of their communication devices.

Quick and easy strategies to try include:
- Decrease the size of the symbol. At times a smaller target requires less focal area and is easier for the child to see.
- Increase the contrast between the symbol/button and the background (for example use a black background with a bright yellow, pink or red symbol)
-Add movement to increase the child's attention to a symbol location. We use video clips inside small buttons to draw the child's gaze to the location of the message.
- Use brightly colored backgrounds for each button that contrast with the other buttons on a page (color response is often preserved in children with CVI)
- Decrease visual "clutter" of symbols (strategies can include using simple line drawings with limited detail and coloring)
- Maintain consistent appearance of symbols. Children with CVI show better visual recognition of familiar images.
- Maintain consistent placement of symbols on pages so that the child can use motor memory skills to locate familiar, taught messages

We have a new little friend, Justin, who is using many of the above strategies. In his first two visits he was introduced to 2 large buttons on both the Dynavox M3 and the Dynavox V. He showed very little visual attention or use of the buttons for communication.

His therapist, Jessica, decided to try some of our techniques for CVI with impressive results. She took Justin down to a 1 1/2" button, brightly colored on a black background. Justin has moved from a simple field of two requests for "more" and "all done" to beginning to learn basic navigation by selecting "Quick Fires" on his home page and then "more" to request his favorite movie song- in 2 weeks! Excellent! Here are two short clips of his last two sessions with us (visit #3 and #4 at our office).

Justin's 3rd visit: http://www.youtube.com/watch?v=ahWztYaFJ6c
Justin's 4th visit: http://www.youtube.com/watch?v=DYCWiyJYWHg