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Blogs & News

Issue 9 - 27 February 2018

Back to Brains

CVI is a label, an umbrella term, for many different neurological visual conditions, each unique to the affected person. You may be someone with CVI, you may care for someone with CVI or you may, through your work, support people with CVI.

If we want our support to be most effective (but not ineffective because it doesn't match), we all need to understand CVI in terms of each individual's condition and how their brain is functioning.

For instance, many with CVI have difficulties recognising faces and / or facial expressions - but WHY?

On one level the answer is 'because they have CVI', but there are a number of underlying possible reasons, such as...

  • Reduced visual acuity, most commonly because glasses are needed for optical or focussing reasons. If there is a visual pathway or occipital cortex cause, the best chance for improving visual acuity by visual training is during the first two years of life, with smaller and diminishing returns thereafter. Beyond age seven, limited improvement can take place. But throughout, the key approach is to use lots of adaptive methods to communicate and teach, matched to the child's needs and abilities. The first is to find out the furthest distance one's face is responded to, and to communicate from within that distance.
  • Reduced speed of visual processing, meaning that one's face needs to stay present in one place for long enough to be recognised.
  • Reduced visual search related to simultanagnostic vision due to the posterior parietal lobes being affected, which leads to reduced visual attention. We know of people who have told us that to recognise a known person they effectively use a scanning method, and quickly look at the pieces of the face in a practiced order. So, if this is the cause, the person might be able to learn to recognise faces.
  • The condition called prosopagnosia - which relates to the temporal lobes not being able to 'match' faces they see to memory. So alternative ways of recognising the person using different senses need to be practiced.
  • A combination of some or any of these.

There is a wealth of knowledge that, if correctly understood, can be life changing for each person with CVI, but this requires three things:

  • 1) A knowledge of which of the different visual difficulties under the CVI umbrella, the person is affected by. This needs knowledge and understanding of these individual conditions, each with its cause and its name.
  • 2) An intimate knowledge of the person and their life to date, including their emotional and behavioural development, as well as, what they know and can do, their learning opportunities and their challenges.
  • 3) Knowledge of any other conditions the person may be affected by, and how this in turn affects everything else.

Why not take a look at our CVI Pathway sections? The Pathway we describe, is the natural order of how our minds process what we see. This order is important, because it helps lead to an understanding of the person with CVI and the visual difficulties they have (like being unable to recognise people visually) and how they deal with this (perhaps by voice recognition).

We all need to be comfortable talking about the brain and how it creates the picture that we see, and through the CVI Pathways we hope to make this information accessible and exciting by increasing our understanding

We believe that those closest to the person with CVI, who know them best and love them most, as both their ultimate experts and champions, are their parents and carers. They play the most important role in helping them to access the world, to learn and to live a full and happy life.

Parents and carers are the people we are aiming to explain the brain to. No specific education, prior knowledge or understanding is needed. We think, with time and patience everyone can learn to understand more about the brain and how it sees, by taking a step-by-step approach.

Through our What Is CVI? sections we explain the different common conditions that come under the CVI umbrella, using everyday language but relating them back to the brain. Through our evolving Home sections, we describe many practical ways to help understand the person with CVI, and learn what is needed to create an environment where they feel safe, and can learn and develop.

Our major new section in Home is all about our Visual Attention and how this is calibrated. This may seem complicated and academic, but it's just another part of how our brains let us focus on key issues, which can be disturbed by CVI. While Gordon Dutton's Blog 20 describes the distractions of a stone in one's shoe, why this is, and how it relates to CVI and attention.

The fact you can read these words means your visual attention systems have sorted out an enormous amount of information, coming in through all five senses, so as to choose and focus on the print - but not the weight of your clothes, nor the ticking clock, or the sounds of birds or traffic outside, or the footsteps in a hall.

When attention is not calibrated well, things that should get attention are neglected, like the bridge Nicola nearly threw her father over into a stream below, or the lorry she nearly walked under. We love Nicola's blogs, they make us laugh, but there's always a serious side!

All of this, from stones in shoes, to throwing dads into streams and not recognising people, whether it's a profoundly disabled child or a high functioning professional, all comes back to the visual brain, and the more we understand it, the more we can support the person with CVI.

We shared a short video (Toy Box Test) that simply seemed to involve a child having to pick a toy out of a toy box. But there's a huge amount to learn from seeing how well this little task is performed - knowledge that can be turned into practical everyday approaches at home.

The group who produced this test are looking into how the brain grows and develops in response to practise, which to us is both fascinating and exciting. We can't make promises about sight improving, but what we do see is huge potential to essentially re-wire the brain, to do the same things in different ways - like learning to scan a face to recognise it, or learning to recognise people by their scent or the sound of their footsteps. This re-wiring, or creation of new pathways in the brain is called neuroplasticity, and we see enormous potential in such teaching and training for everyone affected by CVI at every level.

But there's a but - and it's a big one - you have to know which bit of the brain is affected and how, to ensure the approach is one that can work by being matched to ability - otherwise it will be confusing, difficult (perhaps impossible), and stressful, maybe making the person feel stupid and worthless. And this is where the wrong approach, that is not individually matched to the person's limitations and abilities, can be detrimental.

The foundation of what we share on this website is published scientific research. Our work benefits from the contribution of world leading scientists and academics, who give their time and share their expertise for free, because like us, they want our readers, like you, to be able to support those with CVI who are close to you, as well as you can. By ensuring only scientific foundations, our work is relevant internationally, as a well used and shared resource.

Getting to understand CVI is not quick or easy, but we work with a wide range of parents, and all can learn.

We are all in this together, sharing and developing our understanding of CVI.

Best wishes,

The CVI Scotland Team

PS Everything new can be found in our Updates section, and via Twitter @scotlandcvi and our Facebook page.

  • CVI Pathways
  • Attention & Its Calibration
  • Gordon Dutton's Blog 20
  • Nicola McDowell's Blog 17
  • Toy Box Test
  • Dr Namita Jacob's Guest Blog

CVI Pathways

Take an extraordinary tour through the brains of two girls, one who does not recognise her mother, another who triumphs on a climbing day.

Attention & Its Calibration

Sections explaining how calibration of attention can be diminished by CVI, which can impact every element of the persons life.

Gordon Dutton's Blog 20

Gordon explains the role of attention and visual attention, starting with our inability to ignore a stone in our shoe.

Nicola McDowell's Blog 17

Nicola is increasingly a liability, not only to injury, but to life itself - hers and others.

Toy Box Test

A simple test, explained in terms of the push and pull of the dorsal and ventral streams, and how an understanding can open up learning opportunities.

Dr Namita Jacob's Guest Blog

Self-efficacy, what it is, and why it is important that people with CVI and their carers have it, as well as the duty of professionals to help them obtain it.

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About Us

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