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Lynne: Hi, I'm Lynne McAlister.
Sara: And I'm Sara Kitchen. 
Lynne: And this is CVI 101, an introduction to Cortical Visual Impairment. 
Sara: We have learned recently that Cortical Visual Impairment is a subcategory of a larger group of visual impairment, referred to as Cerebral Visual Impairment, which is any damage to the brain that affects the use of vision. Cortical Visual Impairment includes damage to the visual pathways or visual processing centers of the brain. It is associated with an eye report that does not explain visual functioning, a neurological event that may have caused damage to the brain, and ten visual characteristics as outlined by Christine Roman-Lantzy.
Lynne: CVI wasn't considered a visual impairment until the mid-'80s. Before that, it was just considered to be brain damage. Today, it's the fastest growing visual impairment in developed countries. This is probably because of Western medical advances that are able to keep people alive, who in the past may not have survived.
Lynne: CVI is suspected when the eye report does not explain the functional vision of the individual in question. Eye reports identify ocular visual conditions, but may or may not list Cortical Visual Impairment, so you can't always rely on that report to know if you are working with a student who has CVI. 
Sara: MRIs can be somewhat useful because you can see the areas of the brain that are damaged, but they will not give you a lot of information about what the student's vision is actually like. Brain damage to exactly the same part of the brain in two different individuals could result in extremely different use of vision. So, if you suspect an individual may have CVI, the first thing you'll want to do is go back and look at their medical history for what we call "red flags." Red flags include any sort of incident where the brain's access to blood, oxygen or glucose has been interrupted. Things that could cause this include asphyxia, malformation of the brain, injury, infection, stroke, and low blood sugar in infancy.
Sara: Terms that may indicate a red flag include Periventricular Leukomalacia or P-V-L, Hypoxic-Ischemic Encephalopathy H-I-E, Intraventricular Hemorrhage I-V-H, Cerebral Vascular Accident/Stroke C-V-A, brain tumor, toxoplasmosis, cytomegalovirus C-M-V, and so on.
Lynne: If you notice one of these red flags in the medical background, that's an indication that a child may have neurological differences that contribute to their visual impairment. 
Lynne: Here's a picture of the brain I'd like to use. It shows how visual information comes in through the eye. It travels down the optic nerve to the back of the brain, the visual cortex. Then, it is diverted into two streams. The ventral stream travels through the temporal lobe, and this is where object recognition takes place. This is also called the "what" system. It allows you to identify things such as, "Oh, that's my mother." The dorsal stream travels up toward the top of the brain to the parietal lobe. This area of your brain allows your body to act upon what you're seeing, and is also called the "where" system. This is the part of the brain that tells you the information you need to give your mother a kiss on her cheek.
Lynne: Any time there's damage to any part of this system or any part of the brain in between these systems, it interrupts communication and there is a chance that the vision will not function correctly. I found it really interesting when I did my research on CVI to kind of wrap my brain around the notion that we humans perceive vision as an external event, so that we tend to think visual events are outside of ourselves, and we're looking at them because they're "out there."
Lynne: But really, our brains are using chemical processes to form a picture based on information that's coming into it. And so, vision is actually an internal event. People with CVI who lack of any other damage to the eye itself are seeing everything that you and I are seeing; all the information is going in to their brain. They can see everything. They're just not making that picture. Their brain is not discriminating visual information or maybe not even detecting it. And that is the cause of the visual impairment. It's not that they can’t see. 
Sara: The brain works because it is a network of connections. Each part of your brain is talking with several other parts at the same time. In the CVI brain, there is a lack of connectivity, different parts of the brain are unable to reach other parts and transfer information. These pathways can be built and strengthened through an intentional and systematic approach.
Sara: So, the theory that your brain is hard-wired, and certain parts of your brain have certain specific functions has been disproven. It was thought that if there's damage to any of those parts, then you lost that function forever. Research shows clearly now that the brain is not hard-wired at all. There's a lot of research now about how plastic the brain is. The wiring of your brain changes depending on what activity you do.
Lynne: Let's look at this drawing. It was done by an eight-year-old who has cortical visual impairment. What's really interesting in this drawing is that the eyes and the hair are on the bottom and the mouth is on the top. This child has drawn his own face, but it's upside down. The child described it and said that his eyes and hair were down at the bottom. This is an example of a child who was able to show us what his world looks like.
Sara: If your student's eye report does not explain their visual functioning, and there is a history of a neurological incident, they may have CVI. The third indication of CVI is the presence of ten behavioral characteristics, as outlined by Christine Roman-Lantzy in her 2007 book, Cortical Visual Impairment: An Approach to Assessment and Intervention. We will go into each characteristic in greater detail and include video examples.