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Visual Conditions and Functional Vision: Early Intervention Issues Functional Vision Assessment and

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Title: Visual Conditions and Functional Vision: Early Intervention Issues Functional Vision Assessment and

1
Visual Conditions and Functional Vision Early
Intervention Issues Functional Vision
Assessment and
Developmentally Appropriate
Learning Media Assessment
Session 4
The University of North Carolina at Chapel Hill
Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute
2
Objectives

After completing this session, participants will
1. describe the rationale and purposes of
functional vision assessments (FVA)
for young children with visual impairments.
2. describe the step-by-step process of
conducting an FVA with a young child.
3. identify and describe formal and informal
tools and procedures that can be utilized
as part of the FVA process.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4A
Visual Conditions
3
Objectives

4. describe the importance of, and the
procedures used in, assessing various
visual abilities as part of the FVA process.
5. describe developmental and
environmental issues that can impact
interpretation of FVA results.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4B
Visual Conditions
4
Objectives

6. describe the purpose of developmentally
appropriate learning media assessment
(DALMA) for young children with visual
impairments, how to complete such
assessments, and how the results can
be used to plan intervention.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4C
Visual Conditions
5
Objectives

7. recognize that the results of the clinical
eye exam, FVA, and DALMA are the
basis for developing a comprehensive
intervention plan.
8. summarize the results of the FVA and
the DALMA in a professional, family-
friendly report.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4D
Visual Conditions
6
Functional Vision Assessment

FVAthe systematic
observation and
assessment of visual
functioning in different
routines and activity
settings. Results of the
FVA are used in combination with other
information to identify priorities for
facilitating
development, learning, and optimal use of vision.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4E
Visual Conditions
7
Factors Affecting the FVA

An FVA describes childrens visual
responses
in familiar or unfamiliar settings,
under varying levels of
motivation and alertness,
and
in different environmental
conditions.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4F
Visual Conditions
8
Three Purposes of the FVA

Supplements the results of the clinical eye exam
with descriptions of the childs observable
behaviors that may relate to vision
Identifies childs range of visual function
Identifies priorities and strategies for
intervention

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4G
Visual Conditions
9
FVA and Clinical Eye Exams

Functional
Conducted by TVI, support and input from
caregivers and team
Results provide visual function information
(i.e., how the child uses his or her vision) and
identify childs strengths and needs

Clinical
Conducted by medical professional
Determines health of eyes, diagnosis and
prognosis, visual field acuity, refractive error
measurement, and surgical or medication
recommendations

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4H
Visual Conditions
10
FVA Rationale

Although two children may have the
same visual diagnosis, each may see
and perform tasks, such as playing
with toys and
interacting with
others, very
differently.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4I
Visual Conditions
11
FVA Rationale

The FVA provides information that will assist in
developing interventions and strategies, such as
environmental adaptations and sensory motivators,
that will enhance the childs use of vision for
early learning activities.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4J
Visual Conditions
12
FVA Systematic Process

Review medical records
Receive input from caregivers
and other team members
Make informal observations
Assess visual abilities
Write an FVA report

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4K
Visual Conditions
13
Review Medical Records

The analysis of medical information
including
birth history,
presence of other disabilities,
and
visual diagnosis,
creates a foundation for subsequent
observation and assessment.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4L
Visual Conditions
14
The Caregivers Role in FVA

Observes child at times when the TVI is
not present
Completes caregiver checklist to provide
the TVI with information about the best
times of the day to conduct the FVA
Shares information to help the TVI plan
the assessment and to address familys
specific priorities, needs, and concerns

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4M
Visual Conditions
15
The Team Approach for FVA

IFSP team members can contribute
information about how a child uses vision
during interactions with others. The team
can include
caregivers,
orientation and mobility specialists,
early childhood interventionists,
TVIs, and
therapists such as SLPs, PTs, and OTs.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4N
Visual Conditions
16
Natural Observation

The TVI, caregivers, and other team
members observe whether the child has
unusual or abnormal visual behaviors
and how the child approaches tasks and
explores the environment. The TVI should
observe children during routines such as
meal time watching TV dressing
play groups community outings

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4O
Visual Conditions
17
Assessment of Visual Abilities

Observation of visual abilities
Direct assessment of visual abilities
These procedures vary for each child,
depending on age, cognitive abilities,
and amount of functional vision as
observed during observations in daily
activities.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4P
Visual Conditions
18
Informal Tools and Procedures

Informal assessment ideally occurs
within the childs daily routines in the
natural learning environment, such as
observing the child
playing with toys,
sharing a storybook,
eating lunch, or
interacting with siblings and caregivers.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4Q
Visual Conditions
19
Informal Tools

Examples of
informal tools
include books,
familiar and
motivating toys,
eating utensils,
clothing, and pets.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4R
Visual Conditions
20
Formal Tools and Procedures

ISAVE (Langley, 1998)
PAVII (Chen, Friedman,
Calvello, 1989)
Hiding Heidi
(Hyvärinen, 2000)
LEA Symbol Test
(Hyvärinen, 2000)
Teller Acuity Cards
(Vistech, 1990)

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4S
Visual Conditions
21
External Ocular Status

Appearance of the eyes can possibly indicate the
presence of a visual impairment and quality of
functional vision.
External structures such as the globe, eyelids,
pupils, iris, and cornea should be observed for
symmetry, size, and shape.
Observation of nystagmus, pupillary reflex, and
blink reflex should also be observed.
Erin, 2000 Langley, 1998

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4T
Visual Conditions
22
Alignment and Ocular Motility

The corneal light reflection assessment or
Hirschberg corneal light reflection test is used
to indicate the presence of strabismus, an
imbalance of the extraocular muscles.
During the light reflection assessment, notice
how children move their eyes and head. These
observations can help to determine which eye has
more functional vision and the cause of the
misalignment. Langley, 1998

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4U
Visual Conditions
23
Corneal Light Reflection

A young boy with esotropia, wearing eyeglasses,
plays with pudding at a table.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4V
Visual Conditions
24
Alignment and Ocular Motility

The vestibulo-ocular response helps the eyes
remain in a central position with respect to head
posture when the head moves or is moved so that a
stable visual image can be formed on the retina.
The oculocephalic maneuver elicits the
vestibulo-ocular response and helps to assess the
functioning of the oculomotor system.
Langley, 1998

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4W
Visual Conditions
25
Oculomotor Skills

Examples of visual skills that involve eye
movement are provided below.
Localizelocate pieces of cereal on a
highchair tray
Fixatefocus on a caregivers face
Scanlook for details in a picture book
Trackfollow movements of a family pet
Shift gazechoose between two toys
Eye-hand coordinationuse vision to put
shapes in a shape sorter

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4X
Visual Conditions
26
Shift of Gaze

A young boy shifts his gaze from a red ball to a
white stuffed animal in order to choose the toy
that he prefers.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4Y
Visual Conditions
27
Additional FVA Items

Near/intermediate vision
Distance vision
Visual field
Special visual behaviors
Repetitive behaviors
Use of corrective lenses
Orientation and mobility

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4Z
Visual Conditions
28
Use of Corrective Lenses

A young girl looks toward the viewer while
holding her eyeglasses in her hands.

A young girl with albinism walks toward a yellow
ball that her mother holds across the room.

TVIs may look for developmentally appropriate
perceptual behaviors such as
depth perception,
visual closure,
visual discrimination,
visual association,
visual memory,
visual sequencing,
figure-ground discrimination, and
spatial relationships.

When children do not communicate verbally, TVIs
should observe possible physical responses to
visual stimuli including
eye movements,
changes in breathing pattern,
turning of the head,
movement of an arm or hand
toward a stimulus,
vocalizations, and
changes in body posture.

Additional developmental considerations
include the childs
ability to express or understand
language,
physical stamina,
physical limitations or disabilities,
medication side effects, and
additional time for responding.

Environmental variables may affect a childs
visual functioning. Note these conditions in
natural learning environments during near,
intermediate, and distance FVA activities.
color space
contrast distance
lighting time

Color may impact how children use vision.
Red and yellow may be preferred colors
for children with CVI.
Color preferences
can promote the
use and further
development of
functional vision.

Contrast describes the childs sensitivity
or ability to detect difference of
brightness.
TVIs and
caregivers can
modify the
background
when a child is
having difficulty
completing a task.

During the FVA, TVIs should consider
the childs visual diagnosis and implications
for determining lighting needs
the lighting conditions in each environment,
e.g., artificial or natural and
the childs sensitivity to
light indoors and outdoors
and the need to provide
protection from glare
and/or ultraviolet rays.

Space is the three-dimensional field in which
individuals function in everyday life.
Distance is the amount of space between
the child and an object or activity.
Space and distance considerations
childs physical position
physical arrangement of environment
presentation of activities and objects at
the childs eye level
visual landmarks within the environment
Erin et al., 2002 Topor Erin, 2000 Webster,
2001

Children with visual impairments
and multiple disabilities need
more time to
detect,
recognize, and
act upon an object or person
in their environment.
Brennan, Peck, Lolli, 1992

The DALMA is a systematic way of
collecting information about
sensory preferences,
learning environments, and
intervention materials and methods
because visual impairments affect
how children learn about their world.

Used with FVA to describe sensory abilities
Identifies sensory preferences, allowing
caregivers and TVIs to
understand how to present sensory information to
the child,
understand how to calm or alert the child, and/or
identify adaptations and intervention strategies
to promote effective use of senses.

The Individual Sensory Learning Profile
Interview, or ISLPI (Anthony, 2003a), asks
caregivers questions about how a child with VI
uses sensory information during activities and
routines.
The Observational Assessment of Sensory
Preferences, or OASP (Anthony, 2003b), assists in
direct observations of the childs sensory
behaviors within natural environments.

The ISLPI develops a description of how the
child appears to access sensory information
under specific circumstances and conditions.
It documents
response to visual stimuli
latency of visual response
preferences for types of auditory,
vestibular, and kinesthetic stimuli and
positioning preferences that support
overall sensory responsiveness.
Anthony, 2003a

Gathers information about sensory behaviors
Notes sensory preferences based on the childs
responses, level of alertness, and calming
activities
Compares sensory
use in structured and
unstructured situations
Notes toy, activity, and
motivational preferences
Anthony, 2003b

Assessment results and caregivers priorities
and concerns are the basis for intervention
planning and implementation, including
referrals for other evaluations
adaptations to a childs environment (e.g.,
increase lighting, reduce visual clutter)
and
intervention strategies to enhance sensory
functioning, development, and learning
(e.g.,
allow time for child to respond, choose
toys with high contrast, keep toys in close
proximity to child).

The FVA report is a synthesis of the
information gathered from medical records,
interviews, observations, and formal and informal
assessments. It includes
background information
a narrative description of how the child uses
vision and other senses and
recommendations for referrals,
adaptations, and intervention.

When writing the FVA report, the TVI should
avoid jargon and technical terms,
use family-friendly language that acknowledges
the familys efforts to promote use of vision,
and
provide background information about the childs
visual diagnosis, age of diagnosis, and medical
conditions that may affect visual functioning.

When writing the FVA and DALMA report, the TVI
should
accent the positive aspects of the childs
sensory functioning and
focus on skills that foster the enhancement of
visual function or encourage optimal use of
functional vision within daily routines and
natural learning opportunities.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4TT
Visual Conditions
48
Narrative Description of Childs Sensory Abilities

The FVA report should include descriptions of
the childs visual and sensory abilities
including
attributes of objects, people, and events that
are attended to, including size, shape, color,
distance, contrast, movement, etc., and
characteristics of the environments in which
child was observedlighting, noise, activity,
positioning, etc.

The FVA report should include descriptions of
the childs visual and sensory abilities
including
working distance from toys, TV, books, etc.
visual fields
lighting preferences
optimal positioning for sensory use and
participation in daily activities.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
Visual Conditions
4VV
50
Assessment Summary

Although the clinical eye exam will determine
the diagnosis, prognosis, and visual acuity,
the childs visual acuity may not reflect how
the child actually uses vision. The question
of how the child uses vision in daily activities
can be answered by performing a functional
vision assessment. The results of the
developmentally appropriate learning media
assessment describe the childs use of other
senses and identify sensory preferences.

Early Intervention Training Center for Infants
and Toddlers With Visual Impairments FPG Child
Development Institute University of North
Carolina at Chapel Hill June 1, 2004
4WW
Visual Conditions

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