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John’s Writing

John is fifteen and very intelligent and articulate. John loves English literature, but has one problem - he has terrible handwriting. John has taught himself to touch type very well, without looking, but he knows that when it comes to his exams next year, to pass, his writing needs to improve.

John's teacher is trying to help him, and has asked him to simply practice by copying out some of the text from the book they are studying, I Capture the Castle, by Dodie Smith.

Simply copying the text, means that John does not have to worry about the grammar, or sentence construction or spelling, all of which he finds very easy, he just has to practice his hand writing.

Really concentrating, here's what John produced.

John does not know what he is doing wrong, his writing is all over the place, quite literally.

Depth Map

When you look at something, you don't only see the detail and colour. What you are looking at also has depth, and that depth is created in a part of the brain called the posterior parietal lobes. We call this your depth map, and a good depth map means you can reach for things with accuracy, like picking up a cup.

In this image (above) reaching for a cup is shown with different degrees of accuracy of reach. Where the depth map is not so good, affecting accuracy of reach, this is called optic ataxia. This can make people seem clumsy.

John's Depth Map

John is not particularly clumsy, he doesn't knock things over and can catch a ball. John also enjoys most sports including team sports. These are things that are commonly difficult for people with optic ataxia, and John does have optic ataxia, but why does he seem so different?

John, like the vast majority of people affected by CVI is only very mildly affected. His depth map means his guidance of reach is very slightly affected, just a few millimetres at arm's length, and for most of his life, this causes no difficulties. The only problems are where very fine motor skills are needed, especially fine hand to eye coordination.

Let's look again at John's writing (below)....

This is typical paper used in many schools, very faint narrow lines for the child to write on.

John has to guide his pen to a point on the paper, to start one word after the next, and neatly start the next line. So, John tries to put his pen in the place he wants to write, but it does not go where he wants it to - why?

Because the paper that is in the real world in front of John, and the paper in John's visual brain are in slightly different places. John, like everyone, only has his visual brain as a guide to where things are - but what if his brain has got it wrong - even by only 1-2mm?

So, whilst writing, John tries to correct himself, and tries to move the letters he is writing to where they should be - but where he thinks they should be is not where they actually should be, because the paper in front of him and the paper mapped in his brain are not consistently in the same place. This is very frustrating, and as John becomes frustrated, trying to write in the right place becomes harder, and he ends up writing over the top of words he has already written, making it look like he has terrible handwriting or writing difficulties - which he does, but the support needs to be matched to the known difficulty.

What to do?

At the end of this page are some links, as there are different approaches, including writing tools and equipment, that can help. Each child affected by CVI is different, and a little trial and error is best to work out what is most effective for each child. Local visual impairment service providers and charities may have equipment they can loan to try at no cost. Below is one suggestion, matching the approach to the known cause of the difficulty (mild optic ataxia).

Firstly, give John wider and more clearly defined lines. John, like most with CVI, has typical visual acuity, so does not need the words to be bigger, but he may need bigger spaces between words and between lines to be able to write more clearly. Like this (below):

This is the same handwriting. John's handwriting is actually very clear, but... John will never be able to write neatly where there are very narrow lines. John's margin of error at arm's length is around 1-2mm, and allowing this extra space means that his words fit in the space and then they flow.

John could learn to put his finger where he wants to start writing, and use it as a guide for his pen, and learn to use the thicker lines as a guide to write between. Note: Paper printed with thick raised lines for aided tactile guidance is available for this purpose, see links below.

As always, clutter needs to be reduced. The less John's brain has to visually map, the more reserve is released for John to concentrate. Keep work spaces clear and tidy, and noise and distractions to a minimum.

The Cursive (Joined-Up Writing) Debate

John may find cursive writing easier, because once he has his pen on the paper for the beginning of a word, it stays connected with the word until the end through using joined up writing. Otherwise, each time John lifts his pen, from letter to letter, he has to find the right place again.

However, whilst some children may find cursive writing easier, others find it more difficult, and opinion is divided on what is the best approach. We would recommend a little supportive trial and error.

What Else?

We highlighted this case because so many with CVI are only very mildly affected. For his exams John could benefit from wide spaced dark lined paper, but other than his writing, John doesn't have any obvious difficulties. John doesn't need medical attention or therapy, but it is good for John to know that he is mildly affected by optic ataxia, to help explain other things in life that may be difficult. These will be things requiring fine motor skills, for example:

  • Needlework
  • Surgery
  • Fine drawing / art
  • Some DIY jobs

And with this understanding, where needed John can choose to find different ways to do things, or avoid things, and make choices with an understanding that certain tasks may always be difficult.

Anything else?

The part of the brain affected by optic ataxia is very close to the part of the brain responsible for visual search and attention, and when reduced can cause reduced visual attention due to simultanagnostic vision. The storyboard Sean Reading at Home shows how simultanagnostic vision can affect reading. The majority of people with simultanagnostic vision are also only likely mildly affected. A person can have optic ataxia on its own, but it is common for a person to have optic ataxia and simultanagnostic vision, creating two separate literary problems for the child:

  • Optic ataxia making writing more difficult
  • Simultanagnostic vision making reading more difficult.

Both subtle, in so subtle a way that they may not be obvious anywhere else, but without understanding, the child has unexplained reading and writing difficulties, and the strategies may not be correct, so the child does not learn. We explained a bit more about this problem in the Developmental Dyslexia Paper.

If a child is writing as John does, particularly not able to stick to lines and writing on top of words already written, a simple test of accuracy of guidance of reach is to ask them to put a dot in the middle of a circle, or for younger children, to simply put their finger in the middle of the circle.

Print the image (above) and try it yourself. Most children will confidently move their pen (or finger) through the air and easily mark a point close to the centre of the circle in less than a second.

Where guidance of reach may be less accurate, you may notice one or a combination of the following:

  • It takes them longer and they are slower
  • Rather than move the pen (or their finger) through space, they move it along a surface
  • As they reach the circle, rather than quickly mark the spot in the centre, they hesitate and slow down.
  • Where the mark is not near the centre of the circle, but still maybe within the circumference.
  • Where the mark is outside the circle.

With a little trial and error, trying to mark the centre of a circle of different sizes, it should be easy to establish roughly the distance, in millimetres, of inaccurate guidance of reach at arm's length (arm's length is writing distance), and make the changes needed to help the child.

Writing tools for people with visual impairments.

There are many tools and devices to help people with visual impairments write, as an internet search will show. A little trial and error may be required to find an approach that works best.

For further information on products to help with writing where a person has a visual impairment (and your depth map being inaccurate by only a few millimetres still constitutes a form of visual impairment) you can look at:

Most products are available internationally through on-line retailers. Many products can also be made at home.

John is a character we have made up to explain these challenges, however the issues are based on genuine accounts people have shared with us.

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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.