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Gordon Dutton’s Blog (34) Stress of the New

In her recent Blog (29) Nicola McDowell explains how moving house to a completely new place has resulted in her visual difficulties due to her simultanagnostic vision returning with a vengeance. This observation is very important, just as it is fascinating.

When we visit new places, we are able to embrace the new scenery and quickly build up a visual mental map of our surroundings. This results in our ability to get about progressively improving, because we no longer have to work out where we are and where we are going, it becomes automatic.

Simultanagnostic vision is not conscious. People who have it are not aware that they can only see one or two things at a time. This means that paradoxically, they do not have visual symptoms despite being significantly visually disabled, because symptoms have to be describable. This condition is said to be rare. However, in my experience of having seen hundreds of affected children and many affected adults, - identified because their visual difficulties have been explained to me in great detail, by witnesses like relatives and close friends - I think it is likely to be common, but it goes unrecognised, because most affected people are unaware of what they are not seeing.

For 17 years after her brain injury, Nicola did not know that she had simultanagnosia. It was only when she listened to a talk about the subject, accurately describing many of her experiences, that she came to know the cause and nature of what she now calls her ’visual gremlins’.

As a teacher of children with cerebral visual impairment, she was able to immediately identify with the same visual difficulties that her pupils had. This led her to go on to study the subject in detail. As she learned about her visual condition, she gradually became able to overcome her visual difficulties by devising strategies to do so, including visual search techniques.

But now, having moved to a completely new place, she is having to start all over again. What does this mean?

It means that her principal successful strategy of dealing with her visual difficulties, was to consciously and progressively build up her own personal library of mental maps of her whole environment, both within the home and out and about, by mentally ’photographing’ each perceptible single visual element, and then zipping them up together into holistic memorable visual scenes. This is something that everyone with typical vision, which encompasses many items with each new glance, is able to do without thinking.

So now we have an explanation for why children with CVI have great difficulties going to new places, as do the elderly whose vision is affected by dementia.

The educational implications for children with severe CVI are of course profound. For example, when moving to a new school, or even going on holiday, it’s clear what action needs to be taken if there is a risk of the child becoming disorientated and upset.

The child needs to be given time to actively explore and engage with new places in advance, so as to progressively build up new memories. Key elements of new environments need to be highlighted, to allow the child to progressively build up their own holistic mental visual maps. Moreover, adverse emotional reactions to new places can now be anticipated, understood and prepared for.

Clearly, the same overall ideas also apply to those elderly people whose vision is similarly affected.

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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.