What is CVI?


Strategy from Nicola McDowell

In this section, we use terms introduced in the section Attention & Its Calibrations, please read this section first.

Nicola McDowell had a brain injury when she was sixteen. For the next seventeen years, she was unaware she had CVI. Learning of her diagnosis, has led to her being able to develop a number of useful strategies that enhance daily life, and give her greater independence.

Some of these strategies involve her learning to calibrate her attention, learning not to

  • apparently ignore someone or something that is not seen but is important, like the presence of a close friend, or
  • be overly alert to something that does not require conscious attention, like jumping when someone simply walks past her

There are many examples and Nicola recalls these with warmth and wit through her popular blogs. We hear similar experiences from many people, who can be left feeling:

  • Embarrassed
  • Stupid
  • Frightened
  • Vulnerable
  • Lacking in confidence
  • Apprehensive about going out

Nicola created some strategies to cope with her challenges while she was unaware she had CVI, but these mainly involved her being extremely tidy, ordered and organised, having trusted people close by and avoiding busy places. With an understanding of her CVI, which includes reduced visual attention due to simultanagnostic vision, Nicola is re-training her conscious brain, to conquer the invisible challenges created by her non-conscious brain.

In Nicola's words
At times when I am in complex environments and struggling to see, I have taught myself to be more aware of my vision and what I am actually seeing.

In a sense I have tried to turn the non-conscious attention aspect of seeing, into more conscious vision.

I read about the concept in the book 'The Brain's Way of Healing' by Norman Doidge.

The idea is to take an activity that

- you do every day
- you take for granted and
- generally don't pay any attention to how you are doing it, (even when it is not necessarily working that well).

and focus on it.

For me this was looking (in the book it was walking for a man with Parkinson's disease), and turning it into a more conscious action that you actually pay constant attention to.

For example, most people, when walking, go into autopilot mode (I know I do when I'm in a familiar environment) and they don't really think about what they are doing and what they are looking at. Of course, most people can rely on their non-conscious attentional surveillance, alerting them to the information they need to see to keep them safe. But I can't rely on either my conscious or my non-conscious attention to tell me the correct information, I need to know about the environment I'm in. So I try to remain more focused by 'listening' to what my eyes are telling me and if that means having to look a number of times at the same spot to make sure I'm getting as much information as I can, then that's what I do.

To do this, I have to stay focused just on my vision and block out everything else, including noise, smells and other distractions. So in a sense, I have taught my brain to be more conscious of my surroundings, even when my vision is limited by clutter, but there is a flip side to doing this. When I am doing this, I can't do anything else, like talk or listen to music, as any distractions takes my focus away from responding to what I am seeing.

A good example of when I use this strategy, is to walk through a congested airport.

To do this (staying focused on looking the whole time), took quite a bit of training and this is where mindfulness comes in.

By practicing mindfulness regularly with the help of a guided mindfulness app, I'm now able to switch off distracting thoughts and other sensory distraction when I need to concentrate just on looking.

So when I really need to be aware of what I'm seeing, I can concentrate only on that, and take as much information in as I can, with every single glance to study the environment around me.

It's the same kind of idea as how I can count 80 lengths while swimming without forgetting where I am up to. I used to forget how many lengths I had done after 6 or so because I started thinking about other stuff. Now I just concentrate on my breathing when swimming and remember how many lengths I've done.

Nicola has had to consciously overide how her brain is programmed to stay focussed on something her brain is awarding non-conscious attention to.

This is difficult as it...

  • Requires brain training
  • Can only be achieved with practice
  • Takes time to improves and needs patience

but for those who can do it it really helps the person with CVI to become more independent, and gain more control over their lives.

From Nicola
Even though this was a difficult strategy to teach myself, and one that took a lot of failed attempts before it became effective, it has been completely worth it.

I now feel that I'm much more in control of what I'm seeing at the times when having good vision is really important.

After feeling completely unable to control my vision for 17 years, it has made a huge difference to my life.

Now that I know I can when I need to, use my vision, to ignore the incorrect information, I don't get as anxious about being in difficult environments anymore.

Nicola found this book, The Brain's Way of Healing by Norman Doidge helpful.Nicola found this book, The Brain's Way of Healing by Norman Doidge helpful.


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At CVI Scotland we are devoted to helping people understand cerebral visual impairments, and together working towards developing the understanding of this complex condition.