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Lessons

8d - Impaired Route Recognition

Posted by Helen St Clair Tracy in Level 8 - CVIs Ventral
Published: 28/01/2020, 12:09am | Updated: 29/03/2020, 12:07pm

Video Link: https://vimeo.com/392421295

Knowing where you are going.

It is something we all take for granted, whether it is to another room in our home or workplace, or further afield, walking, driving or taking public transport. Recognising all of these different places and routes requires a very complex mental matching process.

In lesson 2h we described the recognition process (please review if needed) and explained that there needs to be a match between what you are looking at and your visual memory, for you to recognise something.

To recognise something, the match does not have to be perfect between the visual memory and what you are looking at.To recognise something, the match does not have to be perfect between the visual memory and what you are looking at.

The match does not have to be perfect, in real life it rarely is.

A route is slightly different and complicated, because it is a thread of images constructed together to follow a journey, so that when you take the real journey, for example to the shops, your memory and where you are actually going, should match. Not perfectly, but well enough to comfortably be assured that you know where you are going. It is also a thread of remembered changes in direction.

Imagine life...

Often or always feeling...

  • slightly lost
  • slightly confused
  • a little bewildered
  • unsure

Because that confidence of knowing where we are going, that can be taken for granted, is not something many with CVI get to benefit from.

Routes can take a great deal more time to learn for people with CVI.

While changes to routes can be a lot more challenging for a person with CVI.

Where a route is very complex, with regular changes and movement, for example getting to school or work on crowded public transport through a busy city, it can be particularly difficult to negotiate.

Targeted Support

Help the person build up their routes. As with all memories, repetition is key to building stronger pathways in the brain.

Firstly, decide which routes are most important to learn, maybe around a school from one classroom to the next, or through an office, or to get somewhere or to navigate just within the home.

Next, plan to go along the route, with support where needed, when it is quiet.

If a child with CVI is starting at a new school, then ask if they can learn the layout of the building and their classrooms before it is full of children.

Look for anything that is fixed, so very unlikely to move or change, to start building up the visual memories of the route. It might be a building, or tree, or a clock on the wall or window or door to an office or class.

And repeat.

Then, start showing where things change, it might be different parked cars on a road, or posters on a corridor wall that are regularly changed. Where there are these variable elements to the route, find something fixed, so the person with CVI can be reassured they have not gone the wrong way.

And practice, as needed with support, and if ready and keen, try alone, initially at quiet times.

Songs / Rhymes / Poems

We know of many children with CVI who have successfully used a song, rhyme or poem to help them navigate, where learning a song with navigational clues and prompts is easier than visually memorising the route. For example:

School is where I want to be
Look now for the old oak tree
Next the hill to the postal box
Then the garden with giant rocks
Round the bend and cross the street
Wait for the lights to change and beep

Then (to home)

Wait for the lights to change and beep
Round the bend and cross the street
Then the garden with giant rocks
Next the hill to the postal box
Look now for the old oak tree
Home is where I want to be

Traffic

Traffic is always going to be a challenge for many with CVI, and within routes, great care needs to be taken around roads, including knowing where crossings are and how to use them.

Be mindful that stress, anxiety and fear can all have a detrimental effect on vision, and mean that even on a very well-known route, a person with CVI can become disorientated and feel lost. If they are alone, there needs to be a practiced agreed system as to what to do. It might be to call someone, or stand still and ask for help. The person is vulnerable because in these circumstances, by all accounts they are very lost, because their brain can be unable to place where they are.

Safety first always.

Plan!

Visual Behaviours

  • Getting lost
  • Becoming very frustrated if things on a route, change or are moved
  • Finding one has to alter a route can be extremely distressing, for example if a bus goes a different way due to roadworks. This distress is not unreasonable. These routes have been difficult to learn, and they provide a sense of safety and guidance. When they are changed a person with CVI can feel unsafe and even exposed, because their hard earned independence has been taken away, leaving them feeling lost.
  • Sticking only to very well-known routes.

Self Referencing

We take for granted that people see as we do, so if we move something obvious, like a chair, it hasn't changed the room or the house, it's just a chair. That is because without CVI, building up memories of routes is relatively simple, and any changes to an extremely well known route, like in our home, is very easy to accommodate.

Let us think of how that route may have been built for someone with CVI, and the importance of the chair...

The room might not be seen like this (below)

The room may be seen and understood in small parts, put together like a jigsaw, with other memories all slotted in, like the feel of the fabric of the chairs and changing light as the windows are passed.

The route relies upon the visual memories, which are not going to be the same as those with typical vision, so to go upstairs, requires, as a critical part of the route, the chair...

The chair is more than a chair, it is the visual and tactile gateway to the stairs and next level of the house.The chair is more than a chair, it is the visual and tactile gateway to the stairs and next level of the house.

The route is made up of a number of joined up markers.

Without the chair, the stairs may be lost.

This won't be how everyone with CVI might understand this route, but the key issue to recognise is that it is likely to be different from how those with typical vision would perceive it.

If you know an existing learnt route is likely to change or has been changed, help the person with CVI readjust and learn the alternatives (Targeted Support above), whether temporary or permanent.

Checklist:

Before moving on please check that you have understood:

  • What a route is in terms of visual memories
  • What makes a route easy and difficult to remember
  • Why learning routes can be challenging for a person with CVI
  • How to help a person with CVI learn routes

Future lessons will cover further ventral challenges due to CVI including difficulties recognising shapes and symbols, including numbers and letters.

Next Lesson: Level 9a Dorsal (2) - The Map (awaiting release)

Further reading is not required to move on but if interested you many find the following enjoyable:

Nicola McDowell's Blog 24 and
Gordon Dutton's Blog 27, both blogs looking at the importance of visual memories and causes of challenges.

Level 8 Full Checklist

You should understand...

  • Different CVIs (on their own and combined) affect visual recognition in different ways.
  • Not every condition affecting visual recognition is a CVI, and you can name some examples.
  • Why, in terms of learning, things may not be learnt, and so not recognised
  • The three reasons CVIs affect visual recognition.
  • The purpose of recognising faces
  • Why recognising faces is such a complicated brain process
  • Where in the brain the mind's store of faces is located.
  • The name of the pathway from the occipital to the frontal lobes, via the temporal lobes.
  • The different ways different CVIs affect facial recognition
  • The different approaches needed to match the different CVIs
  • Where the mind-store of facial expressions is located in the brain
  • The brain process to correctly recognise a facial expression.
  • How CVI affected this brain process (different reasons)
  • What affective blindsight is
  • What can happen when facial expressions are not recognised
  • The importance of using language to tell people with CVI how we are feeling
  • What a route is in terms of visual memories
  • What makes a route easy and difficult to remember
  • Why learning routes can be challenging for a person with CVI
  • How to help a person with CVI learn routes

Congratulations on completing Level 8!Congratulations on completing Level 8!

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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.