3l - Conclusions

Posted by Helen St Clair Tracy in Level 3 - Introduction to the Visual Brain
Published: 07/03/2019, 12:17am | Updated: 29/01/2020, 11:56am

Video Link: https://vimeo.com/323532850

In this Level we have introduced different elements of the visual processes that come together to create your visual world.

Separate visual processes that come together.

When any of the visual processes are not working so well, it can have a knock-on effect on the other processes, and make your visual world less accurate.

Where these visual processes are not working too well, they can create cerebral visual impairments. Each visual process has a matching CVI, where it is not working so well.

Mildly Affected By CVI

For some, mildly affected by CVI, the visual world their brain creates may just be a little less accurate than typical, maybe making them seem a little clumsy, possibly...

  • because the depth map their brain creates, isn't such a good representation of how far away things really are, or
  • because they don't process movement so well, and things that move too fast are not seen and bumped into, or
  • a bit of both, or
  • another part of their visual brain is not working so well.

Severely Affected by CVI

For some, more severely affected, the visual world their brain creates may bear no resemblance to the world as would be seen by a typical person, and is often frightening, possibly because...

  • they have no language, so what is seen is difficult to recognised, making vision akin to life seen through a kaleidoscope or on an alien landscape
  • the combination of CVIs means things can often seem to jump out and appear frightening
  • in many, the CVIs have been present since birth, so there are no visual memories, other than those that are severely altered, so often the same thing may look different when seen at different times in different circumstances.

In the above examples, for those severely or mildly affected, each suggested reason will have a different helping approach that can work. If the problem is the accuracy of the depth map, there are strategies to help, like reaching for things with your little finger stretched out, to gently touch the object, so as to reach it without knocking it over. This approach can be useful for someone who has inaccurate guidance of reach. Sometimes, when things are not seen because they move too fast, for this person, the optimal visible speed needs to be understood, so that those supporting them can make sure things are not too fast to be seen.

The challenges and difficulties, including the visual behaviours like inaccurate guidance of reach, are not the reason why, someone with CVI has visual difficulties.

Behind the challenges, we need to look at each of the core visual processes and try to figure out where the problems lie.

This can be difficult, and getting to understand is an evolving journey, especially where a person may be affected by many of the different parts of their visual brain not working so well.

To understand how to best support the person with CVI you need to keep asking why?

As the person develops, they will change, and the challenges will change.

Each person with CVI is unique, and understanding them requires a lot of knowledge, including:

The Lists

1) A full list of the person's individual cerebral visual impairments.

2) The severity of each impairment, from mild, to most challenging, and how each one...
Limits the person's access to their world.
Affects their interpretation of their world
Impacts upon their learning

3) The situations that make each impairment better or worse, which may be:
a. Environmental / External (e.g. somewhere quiet, or somewhere busy, crowded or noisy)
b. Internal (e.g. how they are feeling - happy? bored? in discomfort?)

4) Details of other neurological processing difficulties, for example:

How sound is processed if cerebral auditory impairment is also present. How timing is affected (e.g. overall slow processing that needs to be matched)How motor skills are affected (e.g. impaired visual guidance of movement, or cerebral palsy)

5) An understanding of the resulting behaviours which can include:
Adapting to the difficulties (eg. looking away so as to listen)
Reacting to circumstances (e.g. fear of busy places)
Not respond because of lack of perception

6) An understanding of how their emotional, intellectual and social development may have been affected.

7) An understanding of how these factors have affected their learning to date.

8) An understanding of any difference between the person and how others of a similar age are developing (in terms of their learning, behaviour, independence and social skills).

9) Other medical conditions that affect the person.

10) Whether the CVI was present at birth or soon after, or acquired in childhood or later.

Next, you have to look at the past, present and future...

The Past

The past is full of priceless knowledge.

Reflecting - think about times when the person has...

Been most happy

Been most distressed

Really surprised you, doing something you thought was way beyond them

Really focused on something

Seemed most distracted and difficult

And for each of these, think about:

The physical environments they were in

The people they were with

What they were doing

Anything else that seems relevant

See if you can come up with any common themes that explain how the person behaves.

Where the CVI was acquired, also consider the skills the person had before the event, how these have changed, and which are still present.


Your starting point is where the person is now - not where someone else says they should be.

We all exist in the four dimensions of space and time.

With what you know from 1-10 (above)

How much time do you need to allow?

How fast or slow do things need to be moving to be seen?

How big, or small do things need to be, to be seen?*

How are things heard? Is quiet needed to hear? Only one sound?

At what speed do consonants and vowels need to be spoken to be heard?

What environments help the person see, hear and experience the world most clearly?

How many things is the person able to process at once (across all the senses)

How are their other senses affected?

How is their mobility affected?

And how can we make everything perceivable for them.

As well as teaching everyone else make everything perceivable for them.

*This list is by no means comprehensive, once each element of the visual impairment is identified, then the support needs to be matched (see our What Is CVI? sections for more information).

The Future

Plans need to be organic, and as a person develops, everything gradually changes, and needs to be reviewed and re-reviewed.

Consider the person's needs, relevant to them, in terms of:

Their learning and education

Their independence, doing more for themselves and taking more control of their life and decisions

Their social relationships and interactions, so they are not isolated nor lonely.

Final Conclusion

This might seem like a daunting amount to learn, but we know from those who have mastered the subject in relation to someone they support that it quickly becomes second nature. It is also incredibly rewarding. With a greater understanding, you will learn to tune-in to the persons CVI world and experience, and become better at understanding the world from their perspective, and with that understanding, you can make the changes that are needed to help them learn. You will learn to see their world, seeing inside to out (from their perspective, not yours).

In the next levels, we will look at:

  • The individual CVIs in more detail
  • Common combinations of CVIs associated with certain conditions

Before you move onto the next lesson, please check:

  • You understand that your visual wold is created by multiple different processes, working together.
  • You can name many of these different processes, their locations in the brain and related pathways.
  • You understand that anyone can be affected by their own unique pattern of CVI, and it can be present from birth or acquired at any time in life.
  • You understand what seeing inside-out means, and are learning to do it.

Before moving on to Level 4, please review the full checklist from Level 3

  • You understand that the visual world you see is created in your brain, and is a picture of what you are looking at.
  • You understand that CVI is an umbrella term for many individual CVIs
  • You understand what visual acuity means
  • You understand the effect of reduced visual acuity, in terms of a line drawing.
  • You know where in the brain visual acuity is processed.
  • You understand that colour is processed in a different part of your brain to visual acuity.
  • You understand that visual acuity and reduced colour contrast sensitivity are different CVIs that require different approaches.
  • You understand what your visual field is
  • You understand that your visual field is created from information from both of your eyes, which has a large central overlap
  • You understand that the brain flips the image of what you are looking at both vertically and horizontally to process it
  • You know the visual information reaches the occipital lobes on optic radiation
  • You understand that visual field impairments can be caused by different parts of the brain.
  • You understand that movement is added to the image, to match the movement of what you are looking at.
  • You understand movement is a separate visual process.
  • You know the part of the brain that processes movement.
  • You know what the conditions dyskinetopsia and akinetopsia are.
  • You understand that depth is added to the visual picture your brain has created, in the form of a depth map.
  • You understand how the depth map supports accurate guidance of reach.
  • You know the part of the brain that created the depth map.
  • You know there are many different reasons for inaccurate guidance of reach, and specifically what optic ataxia is.
  • You know the importance of identifying the cause of the difficulty - asking why?
  • You understand the difference between visual attention and visual search, and how they are connected.
  • You understand the difference between seeing and looking, and how they are connected
  • You understand the conditions that make visual search more difficult, slow and inaccurate.
  • You know there are many different causes of reduced visual attention.
  • You know what simultanagnostic vision is, and that is can vary.
  • You understand the difference between reflex vision and the visual picture your brain creates that you are consciously aware of.
  • You understand the difference between blindsight, Riddoch Syndrome & affective blindsight.
  • You understand the recognition process is critical to learning.
  • You understand there are different causes to recognition difficulties.
  • You understand the reasons for knowing the cause of the recognition difficulty.
  • You understand the difference between the visual pathways of the eyes and brain.
  • You know where the dorsal and ventral streams are.
  • You understand the difference between the What Is It? And Where Is It? Pathways.
  • You understand the difference between the visual challenges created by the eyes, CVIs and the workings of the frontal lobes.
  • You know each challenge can create the same visual behaviours, but will have a different approach to help the person
  • You understand the term 'control centre' for the conscious decision making part of your brain in your frontal lobes.
  • You understand that your visual wold is created by multiple different processes, working together.
  • You can name many of these different processes, their locations in the brain and related pathways.
  • You understand that anyone can be affected by their own unique pattern of CVI, and it can be present from birth or acquired at any time in life.
  • You understand what seeing inside-out means, and are learning to do it.

Next lesson: Level 4a Self Referencing - Your World

Congratulations on completing Level 3.Congratulations on completing Level 3.


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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.