Cortical Visual Impairment Adaptations

I recently had a reader write me for ideas about a rider with CVI – Cortical Visual Impairment. Although I have not had a rider with CVI before, I did write back with my initial reactions, which I wanted to share here in case anyone finds it useful, and open it up to additional suggestions or experiences!

Cortical Visual Impairment (CVI)

What it is:

  • permanent or temporary visual impairment, caused by issues with the visual pathways or certain brain lobes, which has been caused by asphyxia, perinatal hypoxia ischemia (lack of oxygen to cells and brain), brain defects, head injury, hydrocephalus, and central nervous system infection
  • the degree of impairment can range from severe to totally blind – some compare it to looking through Swiss cheese
  • although the person gives little or no visual response, during an eye exam they show normal pupil reactions, usually normal eye movements, and normal results – so diagnosis is difficult
  • sometimes a child’s vision improves, which is why it’s not considered blindness

What it looks like in children:

  • each child is different, depending on the severity and coexisting disabilities
  • it may affect the language skills in young children
  • spatial confusion is common – may have poor depth perception, and inhibit their ability to grab an object
  • vision may vary – by the minute or by the day
  • peripheral vision may be better than central vision – they may use their peripheral vision to look at something, so that it appears they are looking away, or turning away as they reach for it
  • similarly, try putting the object in different visual fields until the child can see it
  • some children are photophobic
  • some children are light gazers
  • vision may be better when moving (either the child or what they’re looking at)
  • may have difficulty differentiating between foreground and background, such as when looking at a picture – may need to look closely at it
  • the child may be overstimulated visually, resulting in a short visual attention span
  • takes a lot of energy to visually process information – they may tire easily and need breaks
  • try many different ways (and positions) to help the child feel secure – experiment to find what works best for them
  • may need to work on fine motor skills and visual skills separately until they can more readily integrate the two
  • the more consistent and predictable the visual information, the more likely the child can deal with it well – familiarity and simplicity are key
  • the child usually sees colors fine, so use bright colors and images
  • repetition allows familiarity and improved responses
  • vision may be better stimulated when paired with another sense, such as hearing something which attracts their visual attention
  • introduce objects using touch and voice
  • try different lighting to find what helps them see best – lighting from behind, the side, a flashlight, etc.
  • give plenty of processing and response time to what is beeing seen
  • look for subtle responses in the child: change in breathing, shifts gaze, changes body position, etc.

My initial suggestions for therapeutic riding clients:

Take Breaks

I think a break from eyesight is a good idea to try. I would try doing this in several different ways to see what works best for the rider: just closing the eyes while the horse is moving (while sitting and while putting hands on withers), stopping the horse with and without closing the eyes (perhaps asking them what they want) (perhaps focus on feeling the horse breathing), stopping the activity but take a walk break around the arena.

Create a Distraction-Free Zone

It stands out to me that it would be important to have the whole arena or part of the arena free from any visual clutter (and in our barn’s case, where the aisle is right by the arena, free from people moving around there). Somehow creating a part of the arena that is free from distraction. This could have two uses, first to have a safe area of the arena in which the rider can go when they are visually overloaded, and second to have a clear backdrop against which to introduce objects (such as a bright red ball against an all wood wall) so it’s more easy to distinguish what they are seeing.

Use a Consistent Arena Setup

I would also keep the arena setup the same for at least the first several weeks so it’s always predictable visually to them, and then once they learn the objects visually, make changes in the setup, letting them know.

Use Familiar Objects

It also stood out to use repetition and familiar objects (like balls, things from home). So the same exercises every week, or with only slight changes. That is until the rider is comfortable enough with everything that you can change it up.

Have any of you readers worked with a rider with CVI? What did you do for adaptations? Please share in the comments section below!


Note: This is not professional advice, this is a blog. I am not liable for what you do with or how you use this information. The activities explained in this blog may not be fit for every rider, riding instructor, or riding center depending on their current condition and resources. Use your best personal judgement! If you would like to contribute an activity or article, please contact me here, I would love to hear from you!

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