Without further ado, I will introduce Ellen, Marguerite, and Rachel, and they'll be taking you through a presentation on visual impairment. Thanks, guys. Thank you, Gretchen.
I'm just going to share my screen so Ellen can get ready to go and present mode. All right. Wonderful. Thank you so much, Gretchen. wonderful story.
I'm so glad you were able to get the services that your son needs. That's going to start with the assessment that you got, and we'll just roll out from there. So really a great story. Thanks so much for having us and welcoming us to this series. And we're calling it CBI, the hidden visual impairment, because it really is hidden.
It's not well understood. It's often mistaken for other visual impairments. We really need to just bring up everybody's understanding of this and how it impacts individual children in very unique ways. Certainly, that's true of the children that are impacted by strokes.
I'll start off. Ellen Maisel, I'm the director of the CVI Project at Perkins. Marguerite Tabata will do the next section, and she's the assistant director of the CVI Project at Perkins.
And Rachel Bennett will finish the lectures with, she's the... CDI community and content manager and also a parent of a student with CDI. So next slide, please, Rachel. So we call CDI at Perkins, we call CDI cortical cerebral visual impairment, because it's, there's multiple work being done in the field.
And it's called by that by cortical, sometimes and cerebral, sometimes it's also called neurological visual impairment at times. So we're really embracing that cortical cerebral visual impairment as the term. It embraces all the work that's been done so far in CVI, and there's quite a bit that's been done and quite a bit more work to do.
We do know that this is a brain-based visual impairment. The children often will have no impact to their acuity or no apparent eye problem at all. All their difficulties, all their visual difficulties stem from the visual. processing centers of the brain.
And there are a tremendous number of visual processing centers of the brain spread throughout the brain. So it just makes sense that when a child has a stroke, it's in the brain where the visual processing centers are. So we want to make sure that at least every child that has a pediatric stroke is screened for CVI.
We want to make sure that their access to learning is optimal. So it can affect children in multiple ways. It can impact visual attention. So that's just the ability to attend to the world and understand what's going on in the world. And then it can rain.
And some of the children can look very, very visually impaired, really operating as blind children, all the way up to children who are looking at objects in the world perfectly fine, looking at materials perfectly fine. But the breakdown is in visual recognition. They're not understanding what they're seeing.
So that's kind of the range that we see for kids with CDI. And so you can see there's unique needs or unique testing for all those kinds of conditions. Next slide, please, Rachel.
So why has this been hidden and why has it been hidden for so long? I think people have just begun to understand the visual brain. I know when I became a teacher of students with visual impairments, we thought about the eye and that's where vision was and that's where we paid attention to. There wasn't a great understanding of how the brain processes vision until there were better methods to scan the brain. So now that's better, that's understood better.
And we can understand how children might have difficulties because of the impact to the visual brain. And again, there's a very wide spectrum. Children can look very visually impaired all the way up to looking like they have no visual impairment at all, but really struggling to navigate the environment. Struggling to understand pictures, struggling to understand people's faces. There's a wide spectrum.
And there's not a firm definition. So many people don't understand what it is, both in the educational community. My fellow TBIs sometimes really struggle with this idea. And in the medical community, where it's not taught in medical school either.
So there's a need for a real firm definition and some real research around some of the impacts that we're seeing. When you go into the eye doctor, they don't have a tool to see CVI. They have tools to look at the ocular system, the eye, but they don't have tools that says, aha, there's the CVI right there. So it's diagnosed through a group of visual behaviors.
And those visual behaviors that are identified and shared with the doctor are often the basis of a comfortable definition from the doctor. So there you could see that. Teachers and students with visual impairments have to partner very carefully with eye doctors and neurologists in order to share the details of those visual behaviors.
How is that child's functioning impacted in order for that diagnosis to be received? And again, that can just kick off services for a child, which is very important. This can, CDI certainly at some of the...
Higher ends of CBI can start to look like other conditions. So often children are diagnosed with ADHD because in fact they can't shut off the visual system that attends to motion. They're diagnosed with autism because they don't really understand faces or pay attention to faces. So often it's diagnosed for other conditions that are just more well known.
So we're trying to heighten the understanding of CBI. Next slide, please, Rachel. So when we think about vision, we want to really expand our thinking about vision. We want to think about the vision as the eye and the brain working together.
So it's not just seeing, it's not just looking, it's interpreting what you're seeing. It's a whole system to understand our visual world. And we begin this journey at birth where we're in the world and we're gathering all this visual information and we're just growing this enormous visual library. in our brains that we can then use to attack any new thing that we see in the environment and decide what it is based on that vast visual library that we have. So that's the system that's growing when we have vision, is that seeing, looking, attending, and then building this vast visual library.
I watched this little child, she was probably about nine months old, in the carriage at a supermarket. And just watching, she was understanding the interactions between people. She was watching money being exchanged hands. She was watching what made the beep when you scanned the product. She was gathering at nine months old a vast amount of information without anybody explaining it to her, without anybody presenting it to her anyway.
She was just gathering all that. And that was growing and growing and growing her visual library. And this is what's impacted with CDI is this ability to attend and that ability to grow that visual library.
Next slide, please, Rachel. So when we think about visual learning, and we know that learning is tremendous, vision is a tremendous skill that we need in order to understand the world. You know, I've heard everything from, you know, 80 to 90% of what we learn is through vision. And we think that vision really connects all our senses to one another. So we can't really just rely on one sense without having vision support that.
So if I hear a noise in the environment, I turn, I look, I decide it's dangerous or it's not dangerous, and then I return to my work. If I just heard that noise, it's meaningless unless I have that visual confirmation that ties together that concept for me. So vision is a hugely important thing for learning.
So what do we need in order to learn? What do we need in order to learn visually? The first thing we need is to use our central vision. That's this very small piece of the back of your eye, which is called the retina, that gathers all the little details of an object, all the little details of a face.
So if you think you're just looking straight ahead, those are the details you see. You're still seeing in the periphery, but it's vague, and it's maybe just vague shape and color. It's that central vision that's so extremely important for us to understand everything, to understand what an object is, what it's used for, for reading, for writing. That central vision is so, so important.
Not only do we have to use that central vision, but we have to look at something long enough in order to gather the details of it. In order to allow that to become part of our visual library, we have to look at it long enough and understand it long enough. When we see something, we have to shift our gaze, that central gaze, to the different parts of the element to begin to put again those details. We have to, when we see a picture, move our eyes to the different parts of the picture to understand what's going on in that picture.
We also have to use that visual library that links what we're seeing to what we have in that visual library in order to understand what we see. Next slide, please, Rachel. So this lack of central gaze, if the children that have CVI are only using peripheral vision, and this is true of some children, then they're only going to gather certain information.
So what I'm going to ask you all to do is just turn to the side and leave the screen in your peripheral vision and don't look when Rachel shows you the next picture. Go ahead, Rachel. Okay, now you can turn and look at it.
You can see that when you initially used only a peripheral vision, all you had access to was color. That's the only thing that was perceivable by you because you weren't using your central vision. Now that you've turned to use your central vision, you can see a lobster on the plate. You can see my brother-in-law's hands cracking open the lobster. You can see that this is on a table and it's probably at the beach.
So you gather this vast amount of information because you're able to use that central vision. If you're not looking and it's mostly peripheral vision, it's basically just color that you got. Next slide, please, Rachel. So with this peripheral skills, you can't even tell how many things there are.
So again, if you just turn your head and leave your screen in your peripheral vision, Rachel's going to go to the next slide and don't look at the screen. So you can't even tell how many objects are there. You see vague shape.
You see that it's kind of tan, but you can't even see the number of objects there. So again, turn back. And you can see with your central vision, there are three distinct things there.
You can see the facial expressions on those three symbolic faces. You gather those details again. Next slide, please, Rachel. So the next thing we talked about was shifting to elements. In order to shift to the elements, you have to see things long enough.
So what Rachel's going to do, she's going to put a picture up very quickly and just see what you can see from that picture. Go ahead, Rachel. So what were you all able to see there?
Did you see color? You see, were there people there? How many people were there?
What was going on? You could not see that. You could not perceive that.
You could not gather the information because it wasn't there long enough. And you could not shift to the elements. So let's take a look at what that was, Rachel. So you can see now, because you're using your central vision, oh, someone's answering that. The sun is fishing in the ocean.
So you got that blue and you connected it to that previous information that it's blue and blue. So that's probably the beach. That's a great example right there. So now using your central vision, you can see the age of the little boy. You didn't even know how many people were there before.
You can see that the grandmother showing him seaweed. And you can see that there's this weird perspective of Barbie being held upside down. So you can gather all that information, all those perspectives, because you have the ability to look at that picture, look at it for long enough, and to shift your gaze to the elements. Next slide, please.
You can go to the next one, too. And the next one, sorry. So here's an example here of using your visual library. We're all looking at this.
There's nothing wrong with our vision. We see this thing perfectly fine, but we have no recognition of that. But all of us have vast visual libraries. So we reach back into that vast visual library and we begin to attack this item. We say, huh, that's probably a tool because it looks like other tools I know.
It's probably, I probably put my fingers in those two little holes because it looks like scissors. I see a joint there. So I bet you that opens and closes. Again, tapping into that visual library.
It's got a little pokey thing off the end, so I bet it's used for poking or prodding or pulling something up. So I can decide this is a tool, even though I have no idea what it is. I can apply that visual information to that in a very effective way.
In fact, this is a candle snuffer, just so people don't go away wondering. But again, that vast visual library can be applied to understand this. We want to make sure that children have this library of visual information that they can apply. Because you can see if this was a test, I would fail this, but I would be failing it based on a lack of visual information.
I wouldn't have known what it was. Next slide. So when we think about building this visual information in our brains, we want to think about the vastness of that. So it's not just understanding what a duck is in real life, it's understanding pictures of ducks, it's understanding ducks at different ages, it's understanding ducks in different forms, like multicolored ducks.
It's being able to identify duckness, essentially, and then again, applying that information to what I see. So each one of these photographs, which are across the top, have enough visual information, although they look vastly different from one another, have enough visual information for me to identify them as ducks, because I know those features of ducks. Even when I go to the bottom pictures, where you have a bathtub toy that looks that's a duck, it looks nothing like a real duck.
It has enough features to give me that information that it's a duck. No one needs to teach me that. No one needs to teach a child that.
It's in their visual library. Even the sign that shows a silhouette of a duck has enough visual information for me to identify it as a duck. The cartoon-like duck has enough visual information for me to identify it as a duck.
Even when I lose color and I go to a black and white line drawing, it still has enough information for me to identify it as a duck. This is some of the problems that children have with visual recognition. They know things in certain forms, but when they get more highly symbolic, that using that visual library gets to be more difficult. It's not wide enough.
It's not broad enough. It's not full enough. And unfortunately, the images that children are going to have the most difficult time with would be these symbolic images or these black and white images, which are in fact the basis of most children's books. Most children's learning materials in school, most worksheets are going to appear in that form.
Are they accessible for children? Are they accessible for the children to learn? That's one of the questions that we're going to look at when we think about children with CVI. Next slide, please, Rachel. So the teacher of students with visual impairments has an important role here in gathering that functional information from the eye doctor.
We want to determine the ocular status. We want to make sure that there's nothing wrong with the eyes. We want to make sure that there's glasses in case there's any refractive error. We want to make sure that the glasses are in place. And we help to do this in partnership with the medical community, with the neurologist and the ophthalmologist.
And then we'll do functional visions around those eye problems. When we think about the CDI, we're assessing visual attention. visual recognitions because we want to decide what that accessibility is for that child in school, in learning.
We want to know what interrupts visual attention and what supports visual recognition. What effective ways is that child building that visual library? We do this assessment through file review, taking a look at everything that's ever been written medically and educationally about the child.
We rely heavily, every single assessment tool in the world of CVI relies heavily on parents'information because you know your child, you know them across environments, you know across their lifetime, you are the basis of so much of our assessment. We do team assessments to understand what they're seeing in school. We make sure we do observations in familiar environments where children might be operating very well with that visual library, but also unfamiliar environments where...
Things are new. Things are different. Are they still operating in those environments in the same way?
And then we do a direct assessment. And after all that, we're really helping the school teams to understand accessibility for that child. So we can ensure that that child's learning is at the optimum level and delivered at their visual recognition level and visual attention level. Next slide.
Great. Thanks, Ellen. So I'm going to talk a bit about the assessment. Starting with the importance first of a whole child approach. There are so many different factors that build the unique profile of a student with CVI.
So before even diving into assessment, we have to understand the timing, extent, location of brain injury, the child's fine motor abilities, hearing, cognition, communication, gross motor, personal interests, and life experiences. And all of this collective information builds that profile that informs our assessment process. And ultimately... the interventions that we're going to start suggesting for that child.
Next slide, please. As Ellen just mentioned, building partnerships is absolutely key. First and foremost, starting with the parents.
The parents are the child's greatest advocate and know the child best. And we also find a lot of benefits in making connections with the medical professionals, working with educators, speech language pathologists, occupational therapists, audiologists, and orientation and mobility specialists. Absolutely everybody has a role to play with the student with CVI. Next slide, please. So there are many different ways of doing a CVI evaluation, so I just want to talk to you a little bit about the Perkins team approach.
So first, we actually consider the use of multiple CVI assessment tools available to assess the diverse needs of students with CVI. As Ellen mentioned, there's a wide spectrum of presentation, and we want to capture the needs of each and every child. And we also acknowledge the need for ongoing systematic instruction and monitoring of skills in between evaluations.
So very often people see these evaluations as a stake in the sand and then we just move on, but it's the time in between evaluations that really, really matters. What interventions are working? What changes are present in the child's life?
How can we adapt our approach to make better changes for that child? And then in general, we want to continue changing and adapting our evaluation methods and implementation of promising practices based on new information in the field. Again, as Ellen said.
This field is rapidly evolving, so how we're doing assessments today might change in a year or two years from now based on new research and evidence-based practice. And lastly, we just want to have highly qualified teachers of the visually impaired assess our students with collaborative efforts from other team members. So while the TVIs might drive assessment, it's the collaboration from other team members that really drives home those interventions and allows for accessibility throughout the entire day. Next slide. I'm just going to briefly list the CVI tools that we use in our assessments.
If you want to learn more about them, please research them on your own time. They are very detailed and in-depth. There's the Christine Roman CVI range, Gordon Dutton's visual skills inventory, Elle's Ordovus Teach CVI Screenings, the previous questionnaire, and the most recent CVI-related tool is the Visual Skill Assessment Questionnaire.
And for those of you who are parents or teachers, the TeachCVI website actually has a printable doctor's brochure that you can print off to give to your medical provider or other individuals who are interested in CVI. It's a really great resource, so I recommend that you check that out. So before diving into the CVI assessment areas, I want to talk about the importance of identifying co-existing ocular impairments and thinking about the associated implications. So while there are many students with CVI who do not have coexisting ocular impairments, there are many students with CVI who do have coexisting ocular impairments. And so we have to consider those implications first.
So we need considerations for acuity, that's the sharpness of vision, and contrast sensitivity. And I want to pause right here on contrast sensitivity, because there's a big misconception in the field right now that for students with CVI, contrast doesn't matter. It's about color. And, um... minimizing clutter.
And while color and clutter absolutely do play a role in the lives of a child with CVI, there are many students who have low contrast sensitivity. So if you can see this picture I have on the right of an orange plate with orange melon on top, you have bright color and you have reduced complexity, but if a student has low contrast sensitivity, they're not going to be able to see the food that's on their plate. So just another point that we should be considering with our students. We also want to consider ocular motility, visual field, accommodation, adaptation, and color sensitivity. Next slide, please.
And the general theme of when we're evaluating students is really to identify visual attention skills and visual recognition skills, as Ellen also identified earlier. So visual attention being what can the student look at, what will they look at, and visual recognition. What can they look at and recognize?
And our goal is to identify the visual attention and visual recognition skills and identify which circumstances these skills are optimal or reduced. And then we use all of this collective information to trial educational programming supports. And as we move forward, we can't predict the rate and extent of visual improvement with students with CVI, but we always set high expectations for visual improvement.
We always put optimal supports in place so that the child has the best chance of improving their functional vision. Next slide. As I go through the assessment areas, I'm going to be talking a lot about compensatory skill evaluation because this is very much embedded in our CBI evaluations. So for those of you who are not familiar with compensatory skills, they refer to the use of strategies, techniques, and adaptive materials.
that students with visual impairments need to access the general education and common core curriculum. So compensatory skills are extremely necessary and very valuable, but we want to make sure not to confuse them for visual recognition. So here's a really quick example. On the screen I have a picture of raspberries mixed with blueberries.
If a student is able to pick out all the raspberries from this plate, but then has difficulty picking out the raspberries when they're combined with strawberries, Perhaps they're using a skill known as color coding. So they're identifying by color but not necessarily detailed vision. So it's a great skill to have but we need to know this so we're putting optimal supports in place for that student. Next slide. As we go through the assessment areas, all assessment areas are connected so they're never evaluated in isolation.
Any tasks reported by parents or observed or looked at through direct evaluation show skills across multiple assessment areas. So I have a picture right here on this slide of one task we might ask a student to do with us, and it's an animal sorting activity. And in this one activity we would be looking at color, we would be looking at visual field accessibility, the impact of clutter, the impact of form.
So we're looking at many different skills and visually, visual motor skills, many different assessment areas in this one task. And then as we go through all the evaluation procedures, we often find that challenges in one area impact another. And so when we create interventions, it's really the cumulative results of multiple assessment areas. So our interventions are targeting many different areas that the student requires support in. And lastly, very, very important is that all behavior is communication.
So anything that a child is doing, they're doing for a reason. And so when we're evaluating students, we need to be able to identify why the child is doing what they're doing and interpret it correctly so that we're putting proper support. supports in place.
I'll talk more about that in a bit. Next slide, please. So I'm going to go now through all these CVI assessment areas.
And by no means, this is comprehensive. And unfortunately, I do have to breeze through them a little bit. So I'm just going to touch on the area, what we're looking for, some examples of observable behaviors, and some compensatory skills. Again, there's no one size fits all. These are just very broad examples.
And then I'll give you a brief um example of some accommodations or interventions we might put in place based on the assessment of that area. Next slide please. So we're going to start with the impact of color. So really we're looking at how does color impact the child's awareness, attention, or visual recognition, and we're really looking at the impact of color in relation to crowding. So where does color play a role if there's too many colors?
Some observable behaviors you might see in a student with CVI surrounding color might be attending to brightly saturated colors and not attending to dull colors, or being captivated by bright colors, attending to a select set of colors, and they might also be impacted by presentation of color. So while they might be able to attend and recognize a single colored object, if something's multi-colored it might become too visually confusing. So this is where we have to really be quite considerate.
An observable compensatory skill in this area would be color coding, which is what I, the example I used earlier with the strawberries and raspberries. Next slide please. So here's an example of some accommodations we might put in place looking at color.
So you can see color coding with the labeling of the hot and cold areas of the sink. We use color to draw attention to the students personal belongings and support their recognition of those materials. And I've listed at the bottom of each of these slides the different areas that we're also considering because if you remember I said all interventions are cumulative result of multiple assessment areas. So we're using color in these interventions but we're also looking at how we're supporting visually guided movement, visual field accessibility, and reduced clutter for example.
Next slide. Next we look at visual field so if you're thinking about Ellen's simulation regarding peripheral and central visual field accessibility. So we look at this in terms of how the student is aware of objects or things in those different visual fields, established and maintained visual attention, and then recognition. So some observable behaviors surrounding a visual field deficit might include tripping or bumping into low furniture, bumping into door frames on one side or another, falling off curbs frequently, missing a certain side of a book. or food on one side of their plate.
And then some observable compensatory skills might be the student is moving their entire head when scanning or using tactile information. to get tactile cues to get information or using an adult as a resource. So considerations for visual field would be where are we placing our learning materials? Where are we placing anything that we're expecting the student to attend to? So in the picture on the left, having an iPad at the student's right at eye level.
And if you have a left or right visual field loss, think of how much information could be missing if you're thinking about that place setting. So we also think about how do we make something visually accessible and what strategies do we then teach that student so that they can get the information from the missing visual field. The next area is access to people.
And this is where we look at a student's attention to faces, facial recognition, and interpretation of facial expressions and body language. And then we also think about the relation of skill. in regards to crowding. So while one skill might be present in a certain environment, if there's too much going on, perhaps that skill is reduced. So some observable behaviors that might impact that access to people might be no eye contact, limited eye contact, confusing people with similar features, or calling others by different names.
And some observable compensatory skills might be reliance on context or auditory tactile cues, gait, sound of others'footsteps, or coding by clothing color. So there's that color coding again. Or stronger visual saliency. So looking at hair color and style and using strategies to get others to speak. We encourage others to speak.
We get auditory feedback. We don't have to rely on our... Next slide. So we really think about strategies to optimize access to people. So if you think, if you look at these two photos on the screen, a child might be able to identify their mother one day because they remembered that their mom was wearing a short sleeve.
lime green shirt. So maybe they're going by color that day. But if they're around many people who are wearing similar clothing, such as all white or maybe in a uniform, perhaps they have to then rely more on voice cues or height differences or hair color and style.
So we have to be very thoughtful of this in a school environment as to how we're going to give access to other people to the student. Next slide, please. The next area is upper.
and lower limb precision. And this is where we're really looking at hand-eye coordination and hand-foot coordination. And these areas can further be impacted by visual field deficits. So it's really important to acknowledge that the close relationship there and weed one out from the other if possible.
Some observable behaviors in this area might include the student might over or under reach for items or knock things over frequently. They might pause at changes in depth or thresholds. They might reach without looking. or have difficulty orienting puzzle pieces or placing objects in a container slot or other specific area.
And then some observable compensatory skills in this area is that we'll often see students doing a sweeping arm movement. So coming around from the side slowly as opposed to moving directly towards an object and using tactile cues in order to gain information. So feeling in order to find something as opposed to relying just on hand eye coordination and then often relying on memory. A student might be... way more efficient running down a flight of stairs in a familiar environment and then lose that skill entirely in a new environment or not familiar with their environment.
Next slide please. So here's just some accommodations. A lot of our accommodations in this area surround strategies as to how to accommodate for this loss but also color highlighting.
So color highlighting changes in depth, targeted where we want the student to reach, so on the rim of the trash. can. This yellow, the yellow colored ramp is actually a picture from a physical therapist who wanted to help their student walk over an obstacle course. And so this color highlighting helped the student know where to step over.
Next slide, please. Next assessment area is impact of light. So this assessment area looks at the student's awareness and attention to light sources in the environment, which can include target lighting, which is light being shown onto an object or item, backlighting that comes from a TV or an iPad, and environmental lighting, so windows and lamps.
And this area also evaluates the impact of backlighting on visual attention and recognition, so does it support it, and defense to direct input. Some observable behaviors might see surrounding light for a child with CVI might be very distracted by light sources. They might avoid light sources and show light sensitivity. There's increased attention or recognition with backlighting or task lighting, or you might see squinting or avoiding light of different spectrums.
And here we didn't really list any compensatory skills. Light is really a support for visual attention and recognition. And another factor that comes into play with light is that if a child is engaging in increased light gazing behavior, this might indicate visual fatigue. Again, behavior is really, really important and it's important that we monitor these changes in presentation.
Next slide, please. When we're thinking about accommodations for light, it really surrounds environmental modifications and then materials. So here we have pictures of blocking out the windows in a classroom to reduce the light coming in using a light box.
lighting up the target that we want the student to attend to to support visual motor. Next slide please. The next area is impact of movement and impaired motion perception.
So in this area we're looking at the impact of movement in establishing and maintaining visual attention to a target, supporting visual recognition. And we're also valuing over attention to movement, so an inability to disengage from movement. And we're also looking at in this area challenges with motion perception.
So can the child accurately judge speed and the direction of movement and the distance of movement from themselves? Some observable behaviors in this area include the student might be highly attentive and distracted by environmental movement. They might startle like quick approaches by people or objects in their environment, and this is referred to by Dr. Dunton as a looming.
You might see some self-stimulatory behavior. Often we've seen hand flapping, often at eye level. or finger play at eye level to get that movement and self-body movement.
You might see frequently spinning and manipulation of objects or in a really crowded environment the student might move to an area of that room that has less movement to avoid that intense motion. So observable compensatory skills would again just be moving themselves to support visual access so they might do some rocking. or tapping the table to make items move. If the table is really cluttered, if they tap the table, the objects that they want to see might pop out more. Next slide.
Accommodations in this area really include how do we move materials, manipulate learning materials to gain visual attention. We also think about the environment. So if a student's desk is facing a very high movement area in the classroom, maybe we need to modify that. And then we think of it in terms of safety on the playground.
If you have impaired motion perception, you're not going to be able to judge if there's a ball coming towards you or the direction or speed of children running around or a swing coming your way. So we think about it in terms of what strategies can we use in order to increase safety and awareness. Next slide. Next we're talking about impact of clutter and crowding. And so this really looks at the student's ability to attend to, so look at, recognize, or navigate materials or learning environments with varying levels of clutter and complexity.
So some observable behaviors that can be impacted by increased crowding or complexity could be misidentifying complex presentations, reduced ability to navigate cluttered environments. The student might look at and interpret single color materials, but may avoid or misinterpret multicolored materials because the more color and elements to an object there is, the more it might look like fragmented pieces of information. Some of the verbal compensatory skills we see surrounding impact of clutter, the student might create predictable and organized environment.
They might be very organized or they might clear and swipe cluttered areas and tables. They might dump out toy boxes or put their head down or close their eyes or become agitated and even fall asleep. And going back to that importance of behaviorist communication, these behaviors can very easily be seen as task avoidance or disinterest.
or non-compliance when really it's an effort to deal with a very overstimulating and non-accessible environment. Next slide. You can see here there's a pretty big difference in a crowded classroom versus a less complex classroom as far as what's accessible visually.
We think about how we're spacing objects, how we're using light and black backgrounds to reduce that background information. We think about using even muffin trays to help separate out that visual information and modifying worksheets. because they're often very cluttered and inaccessible. Next slide, please.
The next is sensory integration. And this is where we're looking at the impact that simultaneous tactile and or auditory input has on visual efficiency. So some observable behaviors might include reduced eye to object contact when looking or listening at the same time. Children might cry or have meltdowns in really loud, busy or new environments. or they might repeatedly ask to leave an area and become frequently startled.
And some observable compensatory skills we see in this area are the student might close their eyes. try to avoid the room, leave the room. They might grab onto an adult for security, and they might start to default on reliance on their tactile and auditory channels for information because vision is not accessible. And again, behavior is communication.
This can easily, again, be seen as non-compliance, task avoidance, and disinterest when it's not. Next slide. When we think about sensory integration, we think about how we're going to teach that child.
If we're showing them a book, are we reading at the same time that we're expecting them to look? maybe we maybe the child can't handle that we have to separate it out. If you're transitioning down a hallway maybe picking a time where it's less busy where there's less movement less noise and using sound buffers in the classroom to absorb that extraneous auditory input. Visual curiosity so this is where we look at incidental access to the student so we look at what's available in new and unfamiliar environments what's accessible in visual fields and at a distance. So what can the child, if a child walks into a room, what incidental information do they pick up visually?
So some observable behaviors in this area, students might be really attentive and interested in a select group of items because it's what's known to them and what's familiar. They might avoid new toys and materials. They might not look around the environment when you go into a new area or place. They will miss distant information. And they might become easily frightened by unpredictable sounds or happenings in the environment because they can't visually anticipate them or expect them.
So they just pop out of nowhere and they can be quite frightening. So some observable compensatory skills in this area might include walking until stumbling upon an item. So they're not seeing it at a distance and traveling towards it, they're accidentally coming upon it. There might be reliance on context, predictability and auditory cues, or reliance on an adult. So always asking questions to seek that missed information.
Next slide, please. In visual curiosity, we're thinking about where do materials need to be placed as far as how far away from them and how the environment needs to be modified in order for them to access those learning materials and what strategies we can use as educators to bring distant information to the child. Next slide.
So form accessibility. This area evaluates optimal and accessible media form. based on visual abilities.
So again, attention and recognition. So assessment evaluates the accessibility of multicolored materials versus solid colored materials, attention and recognition of two-dimensional, three-dimensional materials. And if you've ever heard of Matt teaching 2D image assessment, this is where this comes really in.
It's really valuable, excellent assessment tool. So... Some observable behaviors you might see in this area include attending and recognizing specific forms of visual information, so whether that be objects and or 2D presentations. They might misinterpret objects and 2D presentations based on different forms or perspectives or size, and they might have a general inability to generalize recognition skills. So some pen story skills you might see around this might include identification errors by color.
They might say that their, let's see, their red spoon, they might see, let's see, I'm trying to think of a good example. I'll just move on. Context dependency, auditory cues, and reliance on additional prompts. Next slide.
So this is a better example than the one that I failed to come up with. But if you think back of Ellen's duckness, think about all the different forms that one object can come. up with. So you can range from having the actual object itself to a photograph of that object. Now it's lost so many different attributes and you've lost different perspectives.
A spray bottle can come in all different shapes, colors, and sizes and it can be represented in sight words or more abstract depictions. So we have to identify what form the student can identify a learning material in and how can we modify the rest of the learning materials to meet that visual need. Next slide.
Marguerite? Yes. I just wanted to check in with you so that we have some time for questions. How much more were you planning to share with us? This is my last slide and Rachel has 10 minutes.
So I think that it would make sense to take a pause after this slide to take questions if that's okay. Sure, whatever works for you. Okay, thank you. So this is just the last area, so response interval. So looking at the time it takes a student to become visually aware of a target, establish visual attention, process and recognize that target.
And I save this for last because response interval really is impacted by all the other assessment areas. So we need to be able to meet the needs of the student by identifying appropriate pause time for response. identifying appropriate materials and tasks in relation to the environment where we use Matt Teejens with the complexity framework and provide proactive planning to minimize visual fatigue.
As Matt Teejens says it's really important to recharge the visual battery. Okay that's it for me. Thanks so much.
So we want these workshops to be interactive so depending on people's availability to stay we'll start with some questions now and then hopefully If Rachel still has time, we can continue her presentation in a little bit. So the first question that I have actually came just to me. Angela, would you be comfortable unmuting to ask your question? Okay, yes. Can you hear me?
Yep. Okay, so I think it was Dr. Mays all in the beginning. who said that we the goal would be to get hospitals to screen children who've had a stroke for cgi and my familiarity with this is i believe i heard that the hospital where dr roman lancey works in pittsburgh does make use of routine cgi screening for children in the field and i'm wondering if any more hospitals have I've gotten up to speed on this.
So I'm just going to repeat that because it was a little hard to hear. So she's saying that she knows that Dr. Roman's hospital in Pittsburgh is doing screening in the NICU and are other hospitals doing that? And I would ask a related question of at what age can you effectively screen for CVI? I can answer that question.
I think my understanding of Dr. Roman's research is that it's in process, so there's been no dissemination or research information shared yet. I know she's having promising, it's sort of a longitudinal thing, like how does a child behave in the NICU, and then you're following them. So, again, you need some time to gather that longitudinal information. think what's needed more in the field for an ophthalmologist and optometrist is a screening that just that lists some visual behaviors that a child has.
And I really like the TeachCBI materials for that. I think it can be a quick one page, two page little questionnaire that parents fill out. I think what should happen, honestly, is that there's one developed that's specifically for the population of children impacted. by strokes. You know, that's a unique, a unique condition that's going to have a set of unique visual behaviors, perhaps.
So I see the development of that as a really interesting goal to pursue. And might that be differentiated by where the stroke occurred? Like, I think, yeah, I think the more we learn about how the brain is impacted. You know, I think people understand the motor conditions that are caused by different impacts of the brain.
And so I think we just need to understand the visual impacts better. So, you know, partnering again is going to be an important thing to do. All right. Julie, do you have a question about your optic nerve damage for your daughter?
Hi, good morning. Yeah, we just happened to have seen the neuro-ophthalmologist over the week, or over this past week, and, you know, he dilated her eyes. She's also suffering from infantile spasm, so she's on Vagabratrin, which is why we're seeing the neuro-ophthalmologist.
And so he's, you know, checking for nerve damage from the Vagabratrin, but our previous visit six months ago, he said, you know, that he didn't see nerve damage. So this visit... When he said there's optic nerve damage, my brain instantly went to, oh, it's a vagabatrin. But then he explained that the patterning was more due to the stroke. And he explained kind of like, you know, when the patterning shows up on the nerve, it's like the last sign, so kind of like a bruise.
You injured it, but it shows up later. But he did not go into detail onto, you know, he had mentioned we had CVI in the past visit. So I...
he didn't really tie into this optic nerve damage and if it impacts DVR or how it impacts her vision, just that she has nerve damage. It seems like it's from the stroke and we'll see you in six months. So my question is, is it the same thing?
How does it impact it? Is it just, is it vision field loss causing? Does it make her CVI symptoms more difficult? I mean, I'm just confused. I'm the pediatric stroke neurologist.
Thank you everybody for joining and thank you our Perkins team for walking us through this very complex area. Can I ask you if you know exactly the areas that are affected? in your child in the brain, because that will help with the answer a little bit.
Okay. Her stroke is in the left MCA. And from our neurologist, it's just isolated there.
Yeah. So I will defer to Ellen more specifics about the visual cortical impairment, but just in terms of the anatomy and the eye that you've been hearing, whenever the connections, the connection, and you can, the YouTube of Dr. Mirabelle's talk will be up. tomorrow in a YouTube channel that we created for these talks guys so you can check it on there because it will help you understand kind of the anatomy on how you get to what but if the connections from the eye towards the back of the brain with the occipital cortex receives the primary information and then starts doing this processing we've been talking today to then get connections to the different areas of the brain to move the hand to talk to like as Ellen said very well, probably every single function in the brain relies on some visual information. If that connection is interrupted in the MCA stroke, it is.
The optic radiations are directly affected. They are interrupted and they probably suffer some damage over there. And also the area in the center of the brain that has the relay between the eye and the cortex and a lot of other sensory information coming in, the thalamus.
may or may not be affected, depends on the stroke specifically. But the answer to your question is what they're seeing in the eye is probably a little bit of lesser brightness on that optic nerve, like a pale kind of signal from the disconnect from the cortex. Because what is not connected and not in use starts becoming smaller.
And that's what you can see in the fundoscopic exam that the ophthalmologist does. And the cortical vision impairment will come from this. Difficulties with the connections and I want to add that with that type of stroke, not only what is going to the back and it's one side, which is the good news, because the babies and the young kids have a lot of compensatory capacity and plasticity to rely on other parts of the brain, but all that goes to the back, then to get to the different areas that need that information to make sense of it, to plan something motor-wise or to try to get speech or a naming, for example, or reading. Those areas will be also probably having a slower connectivity at the minimum.
So, and on top of that, what you just said, the infantile spasms, when the electrical activity is not yet fully restored, controlled, that misses out all these networks that we're talking about. So there are multiple layers in what is happening to your child that could be affecting this. But I think with the finding in the eye, it is related likely to those connections that were damaged that go to the back of the brain. the brain, the occipital cortex. And Ellen, I don't know from what you heard, what I said just now, if you have anything else that you could tell Julie.
Yeah, I think this is exactly the kind of cooperation I think needs to happen between the medical community, educational community, because you have this vast amount of medical information and research, and then we're looking at function. So we would be looking at function of the contrast sensitivity, for instance, that might be impacted. So we're... Our goal is to take the information the medical colleagues understand and translate that into how that function is going to impact learning and then provide that child with the best materials and environment to support that learning. So you see that we're working on the same thing from two different but highly collaborative points of view.
And Julie, remind us how old your daughter is. She is 20 months currently. So that's another general question is a lot of your talk was focused on school-aged children or preschool and older.
What kinds of things can you do in the toddler timeframe? Gregory, you want to take that one or I can? Sure. Yeah.
I mean, really all the principles we talked about can be applied at any age. I mean. What we really want to see early on is active involvement, active engagement, active learning.
So hands-on exploration of different materials, being in different environments and experiences. And I think it's really about taking... the strategies that we suggested, which again have to be based specifically on assessment to support that student, you know, knowing exactly how to optimize the accessibility, but it's really just about bringing those strategies to your child and increasing engagement and experiences.
So we always say multi-sensory learning is a really great approach early on because that's how we get the most information and it's just knowing how to separate that multi-sensory approach to make it accessible for the child, whether it be having an opportunity to to look at something, an opportunity to feel it, or an opportunity to listen to it, and then just having free range exploration. I think Marguerite listed some of the tools that we use, and one of them was the Prevus, and that is a great tool because it can be used in early intervention. The children don't have to have language yet.
They don't have to have necessarily motor skills yet. It's really looking at visual attention, how they access people's faces, that sort of more age appropriate. look at assessments. So that's a great tool for us to use for that age group.
I also want to say as a parent that, you know, you could just try to become a radio parent, really describe everything, bring everything to your child. Don't really take anything for granted, you know, talk about a spoon, have them explore different kinds of spoons, you know, maybe add a light to the spoons. They can look when you feed them and just think about all the different daily tasks and routines and how to make them more accessible for your kid.
Don't have to do anything crazy extra, but just what you do during your day, making sure your child has access to it. And I want to share that there's a Facebook page that's exclusively for parents of children with CVI and Rachel's in charge of that content. Lots of very great ideas shared between parents, observations of kids. So you might find the site helpful. And this CVI Now regular website also is available.
And I wanted to add guys that my experience are you are the ones that bring what you are being told and learn from the CVI experts to the OT and the teachers in school. Like there is a limited amount of time that you have in front of each of these different experts or therapists but you as a parent start understanding what task, how do we do it, how do we go at it and then you have to it's a lot of work but It's very helpful if you can integrate. Sometimes these are not necessarily talking to each other or connected because of the way our healthcare system works and our school system works.
So a lot of it is you bringing the expertise. That's why we're doing this series. If you think about it, we're trying to make you an expert on this. And the reality is you have to. You have to develop some understanding on how to look at your child and trying to understand what they're trying to do.
get the assessments, get the specialist, and then try to get them to work with the things that each of them can contribute, but in a more integrative way. That's been my experience. Parents spend a lot of time trying to get therapists to kind of pollinize each other with the knowledge that they have.
Kate, are you ready to ask your question about partial or mild CVI? Hi, I was just curious, and I think that Ellen answered this already. I was wondering if it was sort of a diagnosis of, yes, you have it, or no, you don't, or if it was a spectrum, or, you know, you can have mild symptoms, or, you know, 10 out of 10, but I think Ellen answered that pretty succinctly. If there's more information, I'd love to hear more. Thank you.
You know, I think one of the things about having your own child is nothing's mild, right? They're your child, they're functioning how they're functioning. So it's not mild to you. You know, it's impacting your child's learning and you want that addressed.
So I think that each assessment is individual for that reason. The results are individual for that reason. And the supports in school are in place for that reason. So.
People do say that sometimes mild. And for me, that feels like, oh, we don't need to worry about it, where I think we do. I think mild still is inaccessibility for children.
So we have to address it. So this is related. Flora, are you comfortable coming on to describe your situation and question? Yes. My daughter is 13 years old now and her stroke is on the right side near the motor area.
And a few years ago, I brought her to the eye doctor doing those, you know, go in the box and then click the light. thing the test and then the doctor turned out saying that she has some partial facial field lost but he didn't suggest us to do any treatment or he said there's nothing to do is the damage from the brain but i do notice that after you know she watched tv for like 30 minutes she'll be exhausted and then she cannot um do another activities at least need to sit down there for 10 15 minutes so i wonder All these, is it related to the visual field problem? And also what we can do next to help her?
I think an individual assessment is really what you're looking for. I mean, there is something to do about a child not having access to a visual field, and that's teaching strategies to scan. There's lots to do about a visual field issue. It's just, it's back to the function. We're interested in the functioning.
We want that child to be able to cross the street safely. We want that child to be able to see every aspect of their world with accommodations, for instance. So I think assessment is a really good start. As far as the fatigue goes, you know, she's watching TV and she's got it in her best visual field and it's still fatiguing her. That's it.
that's you know why is it fatiguing is it too much noise is it too much motion on the screen is it you know is it a cumulus thing after all the other things she's done in the day that's something that really needs deeper assessment I think. Thank you and I'm seeing a question from Stacy are you prepared to ask it out loud? Sure yes um can you hear me okay?
Yes. Okay, great. So my daughter, she's a patient of Dr. Mussolino's. She's diagnosed with a visual field cut and potentially CVI. And she has TBI services in her IEP.
We have not received services this year for TBI. They told us that O&M services may start soon. And we've been told that there's a statewide shortage of TBIs in Massachusetts. And I'm wondering if that is something that is known by the folks at Perkins and if that's actually true, if you could confirm that, and then if there are any plans to be recruiting additional TVIs to provide these necessary services to students in the area. There is a shortage of TVIs.
There's no question about that. I'd like to put a plug in for UMass Boston, which offers a TVI program as a graduate. school program that's really funded heavily.
So it's not a large cost for professionals. So any young person that I meet in the education field, I always tell them to get your master's in teaching students with visual impairments. And I really just tell them how great the job is.
And so there is a shortage. I'd stay in contact with Perkins and just they're trying to hire as many as they can. We are seeing an increase in the number of applicants to the UMass programs.
So So hopefully it will get better. But it's been a shortage for quite a while, and we do need more teachers, absolutely. Okay, that's great to hear. And I would say we've had great experience with former students from the UMass program, like throughout the year, my daughter's four. So we've been dealing with TBIs since she was quite young.
Are there any opportunities to engage TBI services? outside of the school district? Is that something that's possible? Like for other things like OT, we can always go to like children's hospital for those services. And it seems like there's not an opportunity for community-based TBI services.
Is that accurate? I think speech, OT, PT are considered a medical service. So you'll find them in a hospital, but teachers with visual impairments are educators.
So you don't necessarily find them in the hospitals as a place of work. But there are independent contractors, teachers of students with visual impairments that are individual contractors. So let's see. I think if you contact, it's what's called Northeast Consortium, they might be able to post a job on that website.
I can try and find that. Okay, I'll connect with you via email after this. Thank you so much.
I appreciate it. Thanks. I'm going to request if anyone wants to ask a question just to unmute and then if we don't have questions.
and Rachel still has time, we'd continue with her presentation. So are there any questions that weren't in the chat or that I missed? I didn't write it down, but just to piggyback on the last one, we've talked in other kind of realms of different activities and other things that might fit into benefiting physical therapy that's not necessarily physical therapy. specific? Are there other activities that you guys recommend that can be helpful for these children that might, you know, be more applicable to life and not necessarily specific working on their vision?
You know, we talked about adaptive sports being helpful for physical therapy, occupational therapy, music, that sort of thing. What types of things would you guys recommend for families to kind of integrate into their lives? I'll jump in. This is Rachel as a parent. You know, my son, he is a big mover and he loves to move and swimming has been a big, a wonderful support for him.
He loves, loves to swim. I hear that from other CVI parents as well. We just got an adapted tricycle. He's finally able to ride a tricycle.
And so, you know, there's a lot of wonderful supports out there in the CVI community of what parents are doing, whether they're mobile, where they have some complex motor needs or complex communication needs about how to keep our children. active and engaged and you know simple as my son loves to do laundry so all the motor tasks that go around with that that can be paired with vision um really just keeping it to what our kids love to do if that makes sense does that answer your question thanks rachel if you want to share screen or begin again Thanks. Oh, is it up here?
Okay. So I'm just going to close out just talking about my experience as a parent and the importance of collaboration and supporting the whole child. You know, we've heard the many needs children with CVI have and the complexities of this condition in itself.
And when all the providers that are working with our child can collaborate, progress can really happen. So Educational assessment reports really help to support history taking with ophthalmologists, optometrists, neurologists, and other medical providers. Some examples of the collaboration within the educational team, TVIs and speech-language pathologists to collaborate to plan for a total communication plan for a child with complex communication needs. TVI and OT for development discrimination skills, PT and O&M for mobility.
Thinking about if you have a music therapist, the TVI and OT can work to support. bilateral hand movement, support with sensory integration. The TVI and special educator, general educator, reading specialists all really need to collaborate to support that path to literacy and also numeracy. And then also if your child has a BCBA, collaborate with the TVI to help reduce visual fatigue throughout the school day.
So what I want to talk about, I have very two different experiences with my son, Henry, and I feel like I've missed Paige. Here's my son, Henry. He's eight years old.
And I want to talk about what his educational programming looked like without comprehensive assessment and what it has looked like with comprehensive assessments. He's got very two different experiences. He has CBI. He wasn't diagnosed until he was five years old. It was missed by his medical providers.
Unfortunately, this is a common story in the CBI community and there is growing awareness. So hopefully more and more children will be diagnosed early. He has global developmental delay, hypotonia, which is low muscle tone. His ocular conditions include pretty severe nystagmus, optic nerve atrophy, and nearsightedness myopia. So when we were living in Maryland, I'm going to just give his kindergarten year as an example, without comprehensive assessment.
So he didn't have a comprehensive vision-based assessment. You know, the OT, speech, there wasn't really a whole child assessment that the educational team did. They were just relying on past assessments from EI.
early intervention. And so his team had inadequate understanding of his learning needs. They didn't know his unique vision, his visual skills, what his compensatory skills were, as Marguerite discussed, what the appropriate learning media he needed to be able to access the educational content, and really just the impact of a CVI on educational access in general. And so they were using general CVI accommodations at random. You know, they're just using a lot of color.
They're putting up the black trifold, but there really was no systematic instruction. and tasks were inappropriate for his visual abilities and the environments were just too noisy, too cluttered and too complex. And so here's just some examples of what it looked like.
This is him in his kindergarten room. You see the black trifold here, but it's not really doing much because you can still see all the students. It's still really noisy. The table is really cluttered. And he is, you know, his his CVI, he's very impacted.
He's very significantly visually impaired. He does have visual access, but it's really it's greatly impacts his ability to just be in this world. And so here's some examples of the worksheets that were given to him.
You see things highlighted in color yellow. But as I'll mention later, he definitely tore these up or scrunched these up and didn't want anything to do with them. And so these are some of the notes that I got home from his team.
And this is an example of Henry in meltdown mode. You see everything's on the floor or the chair is thrown. you know, had we had another sad day, he wasn't available for learning.
He climbed on the tables, he threw everything to the ground, he tore up the worksheet again, he was kicking and screaming. And like Marguerite mentioned, behavior is communication, right? He was telling us that none of this was accessible for him and it was really too much for his brain to process.
And it was incredibly fatiguing for him. And when children with CVI have cumulative fatigue, right? When their CVI battery is done, it's really hard to get them back.
And so he made very little progress his kindergarten year was quite a stressful. Traumatic year for all of us. But then we moved.
We moved to a new state here in the Boston area. And we had in his initial IP, he had so many amazing evaluations. And this is what his education programming looks like. Rooted in comprehensive assessment. Right.
So his TVI did all the different assessments needed for him. The functional visual assessment, the CVI specific assessments. Right. That included Dr. Roman Lancy's CVI range, the Dutton CVI inventory. Matt Tijan's complexity framework to really look at how to develop a visually accessible day, as well as his 2D image assessment.
And so this found that he was able to recognize, you know, gross form objects, familiar objects, photos of familiar objects, right? Color movement really support, you know, how the distance to put his materials. It showed that he does not consistently see 2D images or black and white text. So you go back to all those worksheets that were put in front of him, you know why he was screaming, kicking and crumpling them up. Right.
And visual clutter, crowding, sensory integration, visual fields and fatigue all impact his use of vision and his learning media assessment. And I want to emphasize the importance of a learning media assessment for a child who is visually impaired with CVI. I was told in my other state that a child that we didn't need a learning media assessment until he starts reading, which is completely false. You need a learning media assessment really early on to know what materials are needed so they can begin their path to literacy. And it's important to do a learning media assessment using a CVI lens because there is an expectation for improvement of functional vision.
So we learn that Henry is a very tactile kid. He also attends to this auditory pretty well. Backlighting helps. Again, those 2D images are difficult to see. And his tactile discrimination activities actually wake up his visual system, which allows him to view more consistently.
we found what font and size and color work for him how books can be modified and other different assistive technology and so here's just all the things all the ways it's a very multi-sensory approach to his path to literacy right he uses print tactile activities which help enhance his use of vision as i said tactile symbols in his calendar system auditory he's learning braille it's just a very multi-sensory approach and so you see his pictures on the right you Right, you see the bus and this is just kind of his tactile wake up. You see his calendar symbol for bus and then you see the word bus and all that is integrated in his concept development of bus and reading. Just some more examples of his educational materials. Very different from those worksheets that we've seen, right?
Multisensory, very systematic and matched to his assessment needs. Here he is again, that's his OT in the middle pictures, his OT and his TBI working together to work on Braille. And usually when he has a Braille session, he then goes to look at the print words and he can read them really well.
So all that is really working well together. And just some examples of his writing using some assistive technology for speech to text. So he's actually reading, he's writing. It's something I never thought he'd be able to do, but it's all because of his team's collaborated.
and had done a really comprehensive assessment. And so just to close out, there's so much need for research for CVI, specifically when thinking about children with strokes, how different types of strokes, the timing of the stroke location, all that impact vision, you know, what's the child's point of view, what's the visual point of view of a child with a stroke, and so on. And so the need for research is paramount as we continue to learn more about our kids. And just to wrap up, CVN.org is, you can learn more about CVI, what it is, how it's diagnosed, and just a wide range of vetted and articles about CVI and to join a parent group.
And that Perkins also has available evaluations as well. And we're grateful for our partners. So I'm going to close out.
Thanks, Rachel. There's a question about will copies of the PowerPoints be accessible? So we're definitely going to share the video recording and we will share the PowerPoint presentations when we can.
It sounds like there's a place on the Perkins side where they can probably share them sooner than we can share them. on the MGH side. So we'll work together to let you know where the resources are.
Are there other questions before we close out today's session? So I don't know if Patty's available. I want to introduce our next topic is on auditory processing, auditory processing disorder, and I'm going to be the parent. speaker and Gail Flood, who's been with us today observing this session, is the audiologist that I'm partnering with. And I think it's really interesting after hearing all of this about CVI, there are so many parallels with what's going on in the brain, processing stimuli that come in through another sense, through the auditory system, and how it can be fatiguing and challenging for the child.
So my even... In the process of preparing for that talk next month, I've revisited, my daughter is now in middle school and we've revisited her 504 and are requesting additional assessments because her sense of self is challenged by the stress of keeping up and trying to communicate at the level of her peers, especially in a virtual educational system. So Patty, do you want to say anything?
I want to thank, first of all, Gretchen for shipping your story in this one, but the last one. And for all the parents in the call, this is a resource. The YouTube channel is coming live to some trouble. All this information right now, all the different talks and educational series that you see on the website are going to be there in the YouTube channel.
So this is a resource for you to go back when something that you see or you hear from your providers, from the teachers, from the community is resonating. And it's like, oh, maybe this has to do with that. We're not expecting that you take in all of this and know exactly what to do. But we're trying to create a resource for the community.
So we look forward to seeing you next month. We are also going to do an offline recording of questions for neuropsychological testing and how to interface with the school. So if you have questions, please get us to us because we want to do that interview with the school specialist very targeted to your questions.
So please share those questions with us. And I think with that, I don't have anything else to say. And thank you for those that could stay this much longer.
And again, thank you to the speakers. Thank you for the invitation. Thank you.
Thank you. It's wonderful. Thank you. Bye. Thank you.