NIVI Protocols
Overall results: 9 participants - 5 demonstrated progress according to data collected by school staff. 1 of the 5 made gains in other areas, but not our targeted ones.
One student with an “improvement” in visual acuity
Scans:
Aubree – demonstrated neural reorganization which showed a relationship with our own findings at
school.
Other scans as they are analyzed.
Research Question #1: What brain changes established the best outcomes? What brain variables
changed most in relation to visual improvement? Look for relationships between visual/functional
improvement and brain imaging.
Paper #1 Visual scores/acuity from Hoyt Table = dependent variable
Description of Visual Function
- Light Perception Only
- Occasional fixation on large objects
- Occasional fixation on small objects
- Reliable fixation on small objects (20/125 - 20/200)
- Reliable Visual Acuity (20/40 to 20/100)
- Completely Normal Vision
Research Question #2: Can fMRI paired with educational assessment show changes in both function and
neural networks? (Aubree)
NIVI Project Summary Fall of 2015 to Summer of 2016
The Neuroimaging and Visual Improvement (NIVI) Project at the ECP conducted in in a joint partnership with the M.I.N.D. Research Network at the University of New Mexico used brain scan technology and educational programming to help us to better serve a group of our students with CVI
and visual processing difficulties.
STUDY SPECIFICS
15 student participants were recruited from the student population at the ECP. The teachers, Maya, Aleesha and Navi were asked to participate and manage “research” classrooms. Students who met the criteria for the project (diagnosis of CVI, parental participation) were identified and placed in
the three classrooms. Our three levels of children - Children with profound visual impairment due to CVI, many of whom have additional disabilities
- Children with CVI who have functionally useful vision and cognitive challenges
- Children with CVI who have functionally useful vision and who work at or near the expected
academic level for their age group
All of the students are enrolled at our school which means they had to have a documented visual impairment. They come from different cultural backgrounds and family structures. The various student’s causes of CVI range from severe lack of oxygen to inherited disorders and everything in
between. We believe children’s etiologies represent what you would find outside of our school as well.
WHAT DID THE DOCTORS DO?
The student’s parents agreed to provide consent to have their children undergo a series of brain scans. Using various scanning sequences and techniques, the scans gathered information on the child’s neurological structure and their resting state brain activity. The doctors did a series of
scans in the fall, obtaining baseline information about the students. In the summer, the students were scanned again to discern whether any changes had occurred. We are still waiting on the analysis of these results. The doctors reviewed the initial results from scans for our staff in Fall of 2015. They gave us an idea of where brain damage was and what we could expect to see functionally in our students based on the damage or preserved areas. To our surprise children who have very extensive brain damage presented very different in our classrooms and vice versa. This taught us that we would have to strive to come up with objective profiles of each student’s visual behaviors and the changes and progress we would want to see over time.
Our research question for the project overall was “Can consistent programming help to elicit changes in brain structure over time?”
This is an exploratory study and there are many limitations. But studies like this are not often conducted on children doing resting state functional Magnetic Resonance Imaging (fMRI) techniques.Because it is exploratory we have the luxury of determining new ideas and objectives as we go through the process of doing the work. We have also done a case study on one student in particular from our Kinder class who showed great gains in visual perceptual skills throughout the school year. She also surprised us by demonstrating that she can see in areas where you wouldn’t expect abilities based on her brain damage. The neurologists conducted additional scans designed to see how her brain was able to access visual information in fields where she should not have vision. The results are still being analyzed however it does appear that her brain was able to rearrange itself and she has vision where she should not be able to see at all.
WHAT DID THE TEACHERS DO?
We gained access to some extra resources and brainstorming about new ways to look at CVI and provided additional support for assessments, goal creation and programming. We also tapped into some resources in the latest CVI research to guide our work and planning.
For our purposes, as teachers of children with visual impairments we wanted to ask some key questions that might allow us to serve these children’s very specific visual needs more appropriately.
What do we want to know?
• Our goal is always to understand as much as we can about the way a child functions visually
and sensorially throughout daily routines and different environments
• Can we increase our knowledge about vision by understanding brain function?
• Can we use our knowledge of the ventral and dorsal paired with scans to better serve our
students and improve visual capabilities?
• Can we use our knowledge of compensatory sensory strategies paired with scans to increase
connections between environment and child?
Specifically
• Can we target specific compensatory skills based on scans and see growth?
• For example – if damage is on left side and we know the child is missing visual information, would we see a difference in the scan and in the child’s ability to attend to information in that area?
Student Profiles and Goals:
We developed objective profiles of children based on a lot of different sources of information that we have access to and have gathered ourselves. Profiles of the students have to be as objective as possible, because we have a population with so many differences, we have to look at them from the professional perspective of understanding their visual abilities and challenges and deciding what next steps (goals) we would like to address.
We used the following tools to get as much info as possible about each child:
- - Eye Dr. Reports/Neurology reports and brain scans
- - Medical histories
- - Outside assessment (when available)
- - Oregon Project, Developmental Scales, Visual Perceptual Testing, The CVI Range, Parent reports, Comprehensive Functional Vision Evaluation,
- - IEP information, Childs Outcomes Summaries
- - Observations in different environments and activities
- - Recorded videos of the children in different activities so we can focus on responses to stimuli and targeted progress.
- - Visual Function Scale
We developed goals based on this information and what little information we gleaned from the brain images and information from the neurology team. This was the most challenging parts. It took a bit of time, but we eventually settled on goals for each child to target for the project. The teachers created their own lists of adaptations they would provide to create environmental modifications so that the children could access the visual information to what we believe is the best of their abilities. The teachers also developed their own data collection and management systems to keep track of the frequency of adaptations and their progress.
HOW IS THIS DIFFERENT FROM WHAT WE USUALLY DO
We typically base goals on functional performance baselines anyway right? But we don’t usually have information about the neurological make-up of our children. We also used some new tools as related to visual behaviors that gave us some different ideas about how we might teach salient features, self-advocacy for visual adaptations and the real needs of the child as opposed to working. Our data collection is based on adaptations, their regularity of use and their effectiveness. We typically have general ideas about these, but usually include them in our initial visual adaptation documents and FVES.
AREAS OF FOCUS
For our students, who all perform at different levels, the project helped us to define (or further
define) what we are really focusing on.
- Children with profound visual impairment due to CVI, many of whom have additional disabilities
The area of communication is the most important for them. Their ability to interact with their world in a more external way is key to learning and growth. This ability is not traditional, but rather based on subtle cues and motor abilities. We learned that capitalizing on cognitive strengths and building on those, instead of trying to target weaknesses, might be more effective.
- Children with CVI who have functionally useful vision and cognitive challenges
These students do not come with all the tools necessary to be able to participate and prepare for higher level academic learning. For them, the focus was on providing specific strategies to elicit participation and maintaining attention to learning and group activities.
- Children with CVI who have functionally useful vision and who work at or near theexpected academic level for their age group
These students have a lot of appropriate skills, but their performance is often undervalued or undiscovered because the very specific vision adaptations they need are not obvious to regular education teams and maybe only minimally so to vision teachers. Confirming appropriate visual supports during pre-academic and academic activities and then teaching them that they need to take ownership of those through self- advocacy and self-efficacy will (we presume) allow them success in many different learning environments.
SUCCESSES
Overall, teacher feedback was positive about the project and the support for their very specific work with their students. In fact, all teachers reported that their involvement in this project created opportunities for all their students (not just those in the NIVI project). They were able to specifically target CVI characteristics they might not have considered in the past. This was largely based on using some emerging tools in our field and having discussions about them.
RESULTS
We were able to use our observations regarding our student’s vision and confirm them clinically.
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