CVI for the TVI June Peg Palmer
Hello and welcome to CVI for the TVI and other professionals, our monthly presentation and discussion around the topic of CVI. My name is Yvonne Locke, and I will be your moderator for today's presentation, which will begin in just a moment. Perkins e-learning webinars are presented throughout the year on a monthly basis. You may register to attend live at no fee or view recorded webinars at a time and place that suits your schedule. The webinar series is just one of the offerings in our professional development program, which includes publications, e-newsletters, webcasts, online and in-person classes, and self-paced study. You can see our entire listings at our website perkinselearning.org.
In today's webinar, Peg Palmer will be presenting What's Next, a Case Study Using a Calendar Box. In our presentation, Peg will be sharing information on how creating a tangible calendar system can help children with CVI understand sequencing. In addition, you will gain insight into how to create a tangible calendar system for each child that can grow with them. And you will learn about the brain science behind sequencing and how it impacts other areas of development.
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Audio and video may not be in sync, unfortunately. Wire connections can be particularly troubling. Usually the connection corrects itself. However, if the delay is distracting to you, you can hide the video [INAUDIBLE]. This event will be recorded and available tomorrow on the Perkins website, including a PDF version of the slide presentation.
Thank you for joining us for this event. We appreciate your feedback and your topic suggestions. And now it's my pleasure to introduce today's speaker. Peg Palmer has been a teacher of the visually impaired for nearly 30 years, specializing in early childhood and CBM. She studied with Dr. Christine Roman-Lantzy for several years in a multi-state CVI training program, has attended numerous workshops and lectures on CVI, and is currently CVI endorsed through the Roman Perkins Project.
Peg has presented on the topic of CVI in a variety of settings, including the NEAR Conference this past fall in Vermont. She is responsible for creating the CVI Committee at [INAUDIBLE], the Connecticut agency that services individuals who are blind or visually impaired, which is devoted to giving Connecticut TVIs a forum to have discussions, study together, and create materials and presentations about CVI. In addition, Peg is an instrumental member of the team that created this webinar series, CVI for the TVI and Other Professionals. And with that, I give you Peg.
Thank you, Yvonne. And thank you for whoever is out there listening, participating. And thank you for participating in any of the other webinars you may have joined us on. I hope this year's series has been helpful in your practice in understanding your students with CVI.
Well, my topic today is object calendars and sequencing and how to help our students understand better time, which is a very abstract concept and can be very difficult to teach. I would like to say right from the start that CVI is not the main topic of my presentation today. But it's more like the engine under the hood. It drives everything. And hopefully you will see that as the presentation moves along.
So I'd like to start with just thinking about that sinking feeling when we lose our calendars. I'm sure we can all relate to the fact that it is not a very particularly pleasant feeling. And for those of us who have a calendar and lose it, we're actually in better shape than a child who's never had a calendar to begin with.
And I think we can all relate to what happens to our students, especially when they're in school, and there is an incredible randomness about what they have to do next. A therapist pops in. How often have I seen right after a big gross motor activity, gym or outside recess, the physical therapist pops in to take our students. It doesn't seem to make any sense at all. It makes sense to somebody in some office somewhere. It certainly doesn't make a lot of sense to us.
And we can frequently see our kids literally going into fight or flight when a new therapist or person comes in to the room and takes them out to somewhere where they are not aware of where they're going or why. So I try to put myself in their position, try and figure out what they feel like when they don't know what's coming next. And I definitely see my students reacting in all of these ways that I've listed here, including full-blown CVI, what we call CVI meltdowns.
So not having that sense of-- they very well may not have a sense of who is talking to them, who has taken their hand, who has taken their wheelchair. They may not have any idea, like I said, where they're going. And they have no idea how long this is all going to last.
I had a student this year who was very severely affected by CVI, and an early phase 1. And she would become violent across her day when transitions would happen. And as we introduced to her this system that I'm going to present to you today, those incidences decreased dramatically, showing us that we were putting her into fight or flight a whole lot less.
So who can benefit from a system like this? Of course, students with CVI and children with additional disabilities, challenges, speech language delays. The two children you're going to see on video today did not have much in the way of language. Motor impairment, cognitive delays-- this system can help all of these students.
When I think about-- just that a quick before I get to showing you some of the fun videos. When I think about why it is kids, our students, are particularly vulnerable in this situation, of course, our students aren't understanding some of the picture calendars that are around the classroom. But they're also not picking up on a lot of the other more subtle cues that the other students understand.
So if a station is being set up, if a table is being set, if someone walks in, all of those things help the other children, who are typically sighted, put together in their head what's going to happen next. But for our students, they're missing all of that. And in fact, they may just be becoming more overwhelmed when this kind of activity is starting to on all around them.
I took this snap of a typical preschool calendar that I came across in one of the schools that I was visiting. I have to say, honestly, I'm not sure a typical preschooler could understand this, but certainly not a child with CVI. The complexity, the crowdedness, the use of all the photographs, and then that finger coming in that gets moved down, there's no way that my student was understanding the situation-- I mean, this calendar. It has been taught to us, to me, from Dr. Mary Morse, who taught me a lot about what I know about calendar systems, that we should pretty much only go three out at a time.
So even this would be better if it just had arrival, breakfast, and morning meeting. And then when those things were done, add in the next three. And you'll see this theme coming up as I get deeper into the presentation.
So I'm going to be showing you to two students today in this presentation. The second one you're going to see is Joe. And Joe's mother asked me to include this photograph-- this was before I knew him-- of a calendar system that had been set up for him when he was-- I think he was-- yeah, he was under three. And again, you can see the complexity of this, the photographs. I mean, they're not photographs. They're cartoons, the crowded.
And it just didn't work at all for him. The reason she asked me to include it-- I thought it was a great idea-- was just to tell people that we might try something. It might not work. But we can cycle back to it and give it another chance. We might just hit gold.
This was a mom of a second grader with CVI who's reading and writing. This is what his mom found him working on one weekend soon after school started. And you can see that it's the beginning of his day, his morning meeting, number corners, his specials. You got to love the spelling.
And the best she could figure out the reason he was doing this was because he didn't have access to the school calendar, the daily routine calendar. And he was trying to commit it to memory by writing it down many times so he would feel less anxious during his school day. That just really struck me about how important it is for our kids to know what's coming next and how important that is to them.
So I've learned a little bit about what neuroscience is telling us about time awareness and sequencing. I'll be brief on this, but just so you have a little idea. Time awareness and sequencing and symbolic understanding, they do not appear to be housed in any one area of the brain but in many areas. So it is still unknown whether a mental orientation in space and time relies on similar or distinct neurocognitive systems.
But it does appear that understanding of sequencing and time can potentially help build and strengthen pathways and effectively helps knit our brains together. And time and sequencing awareness is also associated with language development. So to just rephrase that more simply, it looks like about four areas of our brain are all used when it comes to time awareness, sequencing, and symbolic understanding of what I would argue would be a very beginning of reading.
And in the same way that we're taught that we're changing kids' brains when we use the 10 characteristics, for example, and help them use their vision and grow their vision, I believe we could be having the same effect by helping them understand sequencing time and symbols. So what is an object symbol? It's an object that represents an activity, a place, or a person.
A lot of my kids use the juice box to reference us that they're going to eat. So that juice box no longer just means juice. It means they're about to go to the snack table, join their friends, eat, and drink. And a really outstanding book Proust and the Squid, Maryanne Wolf-- I'll just read you this slide. "When a visual system like a token," which I would argue is like that symbol of the juice box-- "when it's imbued with meaning, our brain connects the basic visual areas to both the language system and the conceptual system in the temporal and parietal lobes and also to visual and auditory specialization regions called associative areas," again, this idea that we are bringing disparate areas of the brain together when we help kids do this, understand time.
So how do we determine if a student's lost in time? I do think it's pretty obvious when you can see a student is lost in time. But who could benefit from this system? Robbie Blaha has put out a really excellent workbook on creating calendar boxes. And she wrote, "students with disabilities, which put them at risk for not understanding, participating in, or directing the events which surround them," those are the students who could benefit from an object calendar system.
So students that are most at risk for being lost in time and lost in space-- again, children with CVI, children with little or no meaningful language, children with empty language-- this reduces their experience and understanding, exploring the world-- children who are having difficulty making transitions, and of course, any other ocular, additional ocular vision loss. So how do you know if your child is ready for a calendar system? Again, this is Robbie Blaha's work.
Do they recognize some people, some sounds associated with familiar activities? Do they recognize people associated with certain activities? Some of my students will see the physical therapist and cry. Just know what know what that means. And do they anticipate a few steps while doing a familiar routine? Do they understand when something's finished? Do they associate familiar objects with that activity? And do they have object permanence?
So where to start? This is usually where I start. This is, again, a shout out to Dr. Mary Morse. She would teach us that for students in a classroom, when you leave your room, it's kind of a big deal. And we want to mark that moment. And she would encourage us to use keys because that's such a natural symbol.
We all grab our keys. When we leave our homes and we come back, that's the first thing we do. So we created this. This was the wall. took a shot of this picture. This is the wall right outside one of a student who just started school at 3:00. Outside his wall are these keys. We used red to bring his eyes over to . We used a greenish band because that's what he liked.
And his job, whenever he leaves his room, is to grab those keys. And his job, when returns to his room, is to put them back. So these are the precursors to before we set up any kind of calendar system for him. This is his pass. This is how we signify you're going on a road trip. And it's go get your keys.
So how do you determine the visual or tactile or both needs of the child? Of course, they use a CVI range to determine what kind of vision my child's using. What are the best symbols to start thinking about building that calendar system? And of course, if there's additional ocular issues, we'd take that into consideration using an ocular FEA.
Calendar systems you should go from left to right, the same way reading does. And everyone should be on the same page in terms of the language. So scripted language is really important. I just took this picture of one of my student's calendar systems.
His shiny cup is to the left, a favorite toy, so very familiar, built on that familiarity and lack of novelty there for them. And then we had already done a key, road trip kind of idea, before we started this. So for this child, first we're going to have snack. Then it's going to be play, free play time. And then we're going out of the room.
And how much language you want to use at that point is determined by the team. But it might be to go to therapy. It might be to go home, whatever. I want to introduce my first video of my first student. A few comments I want to make before I show you videos-- these videos were not originally made for a training purpose like this. And these paraprofessionals and teams you see doing this couldn't have been better.
I wish today that I had handed them my phone and had them take videos of me so that any critique could be leveled against me and not them. I only video sometimes. And you will be seeing some hand-over-hand. Most of my teams are excellent with doing hand-under-hand. Somehow it seems when the video camera would go on my pairs in an effort to show how well a child could do, would go hand-over-hand more. So no criticism meant there, just so you see that.
So I want to show you this video. So my little student here, AJ, has septo-optic dysplasia. We were never really able to find or grow much vision for him. His visual responses were always in his left periphery, needed light and movement. And for an activity like this, we were going in a much more tactile route.
AJ, one of his goals was to put coins into this coin jar. And it was not his favorite activity. I'll just leave it at that. And when AJ decided he was not happy, he could really let it be known for quite some time. So we were always trying to keep AJ on that fine line of pushing him to do his work, but keeping him from having a meltdown.
This was the first time we'd tried anything like this with him. This was not a calendar box. This was a first-then box. So it had two chambers. And his aide, his paraprofessional, was very skeptical and nervous to try it. She thought that by showing him the juice that he was going to get once he finished his coins, it was going to distract him and throw him into a meltdown long before he finished his work. But we decided to give it a try.
[VIDEO PLAYBACK]
- Piggy bank first and then juice. Good job picking up, put in the [INAUDIBLE]. Pick up, put in.
- Pick up!
- Piggy bank first and then juice. Pick up. Good job. Put in. Nice. Pick up. Piggy bank first then juice. Nice job.
[END PLAYBACK]
So I think you can see the dramatic effect that it had to show AJ what was going to happen after he finished his coins. And by the second go through, he was not just relaxed, he was laughing. If I tell you we never saw AJ laugh while he was doing his piggy bank work, I'm being serious. So that really helped this team understand how much an effect that this kind of system has for our kids.
A lot of times I get asked, well, why aren't words enough? My student understands that. If I say piggy bank then juice, he understands juice. And AJ did understand. But I am now learning to explain to people that a word hangs in the air for a fraction of a second. We don't always know if our children are paying attention. We don't even always know if their processing has caught it. We use visual cues all the time to boost our memory and our recall.
And then last, although there's many other reasons for this, symbols can become ways for some of our students to communicate with us before they have communicative language themselves. One of my students who was using the keys, and he was just at that stage. We hadn't moved into a calendar system yet. And the keys were always hung by the door.
And this little boy loved to go take walks in the hallway. And after a few months of consistently giving him his keys and pairing it with his going out for his walks, they found him finding his way to the door and finding his keys. And it was his way of asking, I want to go for a walk. So I want to introduce to you Joe.
Joe is just turning three in this video. And I videoed him over the course of over two years. Joe was an extreme preemie. He's aphakic with ROP. At this point, he was undiagnosed with CVI. But he is now diagnosed with it.
When I first started visiting Joe in his preschool class, what I saw was-- and I did not video this was-- Joe would just run around and around and around the periphery of the classroom. And it would make me wonder if he was relying on his dorsal stream because he didn't seem to have much of a what system with his vision. But again, at that point, he didn't have a diagnosis. It was just something I was thinking about.
And I caught this, one of the rare times in the first month or so of school when he first started, where he was actually sitting and joining us and doing something, so just to give you a little flavor for what Joe was doing.
[VIDEO PLAYBACK]
- [INAUDIBLE]
- Do you need one? Can you put it in? Can you give that one to Joe? Hang on. That one's for Joe-Joe.
- [INAUDIBLE]
- Want to give him this one?
- [INAUDIBLE] [INAUDIBLE].
- Need another one? [INAUDIBLE]?
- No.
[END PLAYBACK]
So that gives you a little idea of Joe. He wasn't aware of his peers around him. He wasn't putting things in. That was pretty typical of his play. He was interested in the back lighting and the bright colors. And as I said, it was one of the few times that we could get him to sit and just focus on something.
So was Joe ready for a calendar system? A few months passed, and the team worked really hard and very consistently. They decided not to go with keys. They went with a star, which you will see, and the star was Joe's hall pass. And paper towel was his symbol for bathroom. And he went into the boys' room a lot because they were working on toilet training him.
So one of the things you'll see in this video is one of the team members hands him the paper towel just in midair. And it worked out fine. In general, though, we recommend that if it's a symbol, back it, maybe Velcro, so that it calls attention. So the child understands this is more than just a paper towel. This is my symbol paper towel.
Now, obviously paper towel is something that he interacted with every time he went to the bathroom. So it was an excellent choice. So watch what happens. So this is a few months later. I don't remember exactly how many months later.
[VIDEO PLAYBACK]
- Sorry. [INAUDIBLE].
- [INAUDIBLE]
- Good boy. Hold on. [INAUDIBLE]. star. Hey Dennis, put it in your backpack.
[END PLAYBACK]
So you see what happened there. I think he became a little distracted by the paper towel and was certainly not automatically grabbing his star yet. But you see how they had it laid out. And his job was to grab it on his way out and always on his way back in. So he had lots of chances to use it,
Around the same time, Joe's family asked if they could start an object system at home. And they sent me this video of Joe's using his object symbol, object calendar at home. What I want you to watch here is the way Joe is trying to communicate with his m touching that tray. It's so amazing.
[VIDEO PLAYBACK]
- Joe, I know you want to eat. Sit down. Sit down. We need to wash hands first. Wash-- wash hands first. Wash hands first and then we eat. Come on, Joe. I need you to get out of your chair. Come wash your hands with mama. Come wash hands.
[SCREECHING]
I know you're hungry, but you didn't want hands yet. Hannah washed already. Wash hands first. Sorry. Wash hands first. Then we eat, let's go. Wash hands first. Oh, no. [INAUDIBLE].
[END PLAYBACK]
We see in that one, the family was also using the same symbol for bathroom. And you also saw it seemed like a pretty clear understanding on Joe's part that this was not going the way he wanted. And that his trip to the bathroom here was not his first choice by any stretch.
Knowing what I know about Joe today, I think we all would have chosen some different objects for him, objects maybe that had light inside them, objects that had movement to bring his vision to the symbols as well. But we can't go backwards. What do they say about hindsight? 2020.
Over the course of probably a year, Joe was now able to have a three-slot calendar system to show him the next three things that he was going to be doing. And as I said earlier, three is generally suggested to be the most that we would want to share at any one time. So I'll have you watch what this looks like in school now.
[VIDEO PLAYBACK]
- First we're going-- no. Well, first we're going to do bathroom. Then we're going to do [INAUDIBLE]. Then it will be time for snack. So get your towel. It is time for ba-- No. That's after bathroom. Bathroom first.
- [INAUDIBLE]
- Yes.
[END PLAYBACK]
So a couple of things there. He reached for probably a preferred activity. He was able to have a little bit of conversation with this paraprofessional and that she was able to respond to him and talk to him about that long before he could tell her what he wanted with words. You see how competent he's become, pulling his star off the side of the wall now.
And if I had taken this shot at this point, Joe was walking all on his own to the bathroom. So it was totally clear that he understood that that was where he was supposed to be going. Then began to encourage Joe to do more calendar exploration on his own. I'll just let you watch this one.
[VIDEO PLAYBACK]
- So bathroom first, then snack, and then nap.
- And then when-- do it one more time. And this time, when you feel it, you can let go.
- Bathroom first. No, then snack, not yet. And then that. So first get your bathroom. Get bathroom. Let's go. Get a star. Don't open that door yet. No. Get your star. Go find your name. Can Joe open the door [INAUDIBLE].
[END PLAYBACK]
So a few things that I noticed on this when I watched this one today, everyone is very sensitive to Joe's latency and waiting for him to process information. And that's really been a big help. Also, the complexity of what happened when he got to the door, and all his classmates were all in front of the door. Star-- it got lost. He forgot about star. So he had to be reminded again.
And around this time, we started noticing lots of things happening with Joe. And Maryanne Wolf, who wrote Proust and the Squid, she writes about how reading, which I would argue that this is a very, very early form of that-- reading connects regions in the frontal, temporal, parietal, and occipital lobes, in other words, select areas from all four lobes the brain.
And we were noticing big changes in Joe around this time. He was participating in group activities. He was clearly enjoying beginning and understanding the beginning, middle, and end of activities. He understood a lot more language, was much more organized. And we also noticed him using his symbols in ways that are undeniable that he was understanding this.
One day I was following him on a pretty long route to his OT. Well, I was about 8 feet behind him. He was leading the way. And he got to a place where he had to take a left or a right. And we'd already been out walking for probably a minute and a half.
And I saw him stop, looked down at what was in his hand, which was his symbol for OT, and then take the right to go to OT. So it was like when any of us get in the car and think, wait, where am I going, and check our calendar. That's what Joe was doing.
By the end of his second year of preschool, Joe was building his own calendar system. So I'm sorry for such narrow range of my camera. But on the left of his calendar box now is a bin full of about-- there's probably about-- I think we counted about 12 or 15 symbols. And Joe's job now is to find his symbols and build his own calendar.
We always had, which you couldn't see, and I forgot to mention. We always had Braille in the three chambers, one, two, three. But his vision had started to improve dramatically, or his visual interest had improved, or maybe all of the above. And we've put the written letters, the written numbers as well.
We also noticed that Joe was becoming interested in a lot of the letter cards that were named cards that some of the other children in the classroom were using and enjoying. And because he showed us that interest, we added that in to his calendar building. So take a look.
[VIDEO PLAYBACK]
- First play. [INAUDIBLE], first play. Yeah? Put in number one. Put in one. Put in, Joe, and put-- yeah, put it in, play. And then let's do [INAUDIBLE]. Put in, honey. Put play. That's this one. Then project. No, not art, project. Yes, thank you, project. Project and then--
- Nice job, Joe.
- --bathroom. Thank you, Joe. Put in bathroom. Go ahead, honey, put it in. Now go ahead put in. Put in number three. Joe. OK, yep , get play. Go ahead. All right, go play. Go have fun.
[END PLAYBACK]
About this time, we noticed one day Joe was standing by his calendar box, which was always available to him and which he did go over and check from time to time. And he was crying. And we were shocked because Joe, I don't know if he'd ever cried in school. And someone noticed that the first two chambers were empty because he had finished. So in this case, it had been play and project.
And the last chamber was supposed to be the symbol for going outside, but somebody had changed it. And it was a therapy symbol. And Joe loved going outside. So he went over. He checked his calendar and discovered that he had therapy and started crying. As soon as the team member who found it figured it out, switched the symbol, he was fine.
So again, all these ways that Joe was telling us how much meaning this had for him. So how to select the objects-- again, as I mentioned, if I could go back and do this again, I would have some backlit items for Joe in that, something with movements in it to engage his vision earlier on. But of course, for a child with CVI, a student with CVI, consider the complexity, the color, the movement, the light, novelty. You want to go with very familiar. Want to go with the things that they're actually interacting with.
And for all calendar systems, obviously you want things to be easily replaceable. One of my students and I once dropped his keys down the elevator shaft. So it was really great that we could just replace that really quickly. Of course we always use caution with use of miniatures for all of our students. Objects should be familiar and concrete. They need to speak to our vision system and/or our hands.
And as I talked about, the language should be scripted to ensure consistency. If you think back on that bank of videos around Joe, they were using the same words over and over and over. So I just listed for you some of my resources. The Robbie Blaha workbook is so helpful.
There's a bunch of articles out there now. Paths to Literacy has carried some really nice pieces on setting up sequencing boards, object calendar systems specifically for children with CVI. And then I just wanted to give you a little bit of update.
About six months after I finished seeing Joe, then he moved on to another program, I got this video. He was now using, very well, a very complex screen talker. And here he is requesting to play ball in therapy.
[VIDEO PLAYBACK]
- I want ball.
- Beautiful job. Thank you.
[END PLAYBACK]
And just because I thought you at all enjoy this.
[VIDEO PLAYBACK]
- Ready? Say I--
- Ah.
- Want.
- Wa.
- More.
- More.
- Bubbles.
- Bubbah.
[END PLAYBACK]
As I mentioned, Doctor Mary Morse was really instrumental in helping me learn about calendar boxes and most especially, my thanks to AJ and Joe, their teams, and their families. And I would just close with this most handsome picture of Joe taken just a little while ago at the end of his school year.
So that concludes my presentation. I don't know if there's any questions. If there's any questions, I'd be happy to address them.
Yes, hello. This is Yvonne again. Just waiting for some folks to finish writing a couple of questions in our box. So our first question is, can you speak a little bit more about the other areas of learning that happen using calendar box systems to help our teams understand their value?
Well, I would say that there's just-- it's almost like an explosion of learning. We get a much less stressed out student. We get a happier student. We get a student who's beginning to communicate with us. We get a student who's using language more, understanding some math concepts, some of them understanding some written words, a much more organized student. And all that is brain growth that comes from helping them learn where they are in time.
Thank you. And then our second question is, do you that the idea of visual salient features into the calendar system use?
Yes. Our understanding of Joe-- in this case, Joe's vision-- and in my two subjects in today's presentation, you could see there was maybe more of a tactile approach to their calendar system objects that we chose. Like I said, if I could go back and embed stronger visual character-- stronger visuals for some of Joe's objects, I would have. Yeah, I definitely would have done more with salient features, like I said, using maybe things that had lights inside them for him.
He didn't have a favorite color. But movement seemed to attract him at that point. So yeah, I wish I could go back, and I would have done that, yeah.
Thank you, Peg. And one more question, for people who are new to calendar systems, if it's not something they've worked with before, if they're a TBI or if they are someone on the team who wants to implement, what would you recommend for maybe one or two resources for them to use to help get more information?
I think the calendars for students with multiple impairments by Robbie Blaha-- you can get it off the Texas School for the Blind and Visually Impaired. Although, it's not CVI oriented, it very much lists out the steps for how to help a student start down the road of understanding sequencing and time. That's probably where I'd start.
Thank you. Well, thank you, Peg, for sharing your knowledge on this important topic. We really appreciate it. And thank you to all of our participants for joining us today. We hope you found this webinar to be informative and that you will join us for future webinars.
Be on the lookout in your email for a survey asking for your input and ideas, as well as an announcement for our September webinar, the details of which will be included in the announcement. Again, thank you for taking the time out of your busy schedules to participate. And good day to all.