How can we adapt for Cortical Visual Impairments?

What is CVI?

    Cortical visual impairment (CVI) is caused by a lack of oxygen which disrupts the posterior visual pathways and/or the occipital lobes to the brain. Lack of oxygen also causes neuromotor disorders such as Cerebral Palsy (CP). This explains the correlation between CP and CVI. However, CVI is the most common form of visual impairment and can affect other patients diagnosed with seizure disorders, autism, neurodegenerative conditions, and brain injury.

Posterior Visual Pathways include:

• Lateral geniculate nucleus
• Optic radiation
• Primary visual cortex
• Occipital Lobes:

Image from: https://www.reviewofoptometry.com/ce/understanding-cerebral-vision-loss

Image from:https://www.health.qld.gov.au/abios/asp/boccipital

          The visual system is divided into two sections: the ventral stream and the dorsal stream.  The ventral stream allows for recognition and the dorsal stream subconsciously analyzed the scene at the moment and guides movement. CVI has shown to have effects on both of these pathways. Damage to the ventral stream can lead to the inability to recognize faces and objects. Any damage to the dorsal stream can lead to difficulty in spatial processing.  

Image from: https://visionhelp.wordpress.com/2012/08/11/the-three-as-autism-aspergers-and-automobiles-part-5-visual-spatial/ventral-dorsal-stream/

Common Characteristics

    The vision of a client with CVI changes day by day; some days may be better than others. The peripheral vision is not impacted by CVI therefore most clientren with CVI use peripheral vision to see.; the color portion of vision is also not affected by CVI. The best way to understand what CVI appears as is to describe that it is like looking through a piece of Swiss Cheese. As stated before the dorsal stream may be impacted causing issues with depth perception. Vision may also appear better when the client is moving.

Adaptations

    There are special ways to adapt daily living and therapeutic sessions that will result in a better quality of life for clients with CVI.

• Give break times throughout the session. There is a great amount of energy needed to focus on visual task and breaks are needed to refocus.

• If seeing is the main task at hand the client needs to be comfortable to allow for full focus.

• Provide head support as needed so the visual field is not being shifted.

• If the task requires fine motor coordination and visual coordination, focus on one task at a time. Once both are mastered then combine the task.

• Keep the items used in the session simple and the environment uncluttered.

• When it comes to choosing items for a session familiar and real objects will provide the best results.

• Repetition is key.

• Find items, songs, or interventions that motivate the client.

• Vision is stimulated when paired with other sensory systems.

• Use bright colors such as: red, yellow, pink, and orange. Mylar tissue evokes a visual response and partners with the auditory response of the paper.

• Locate the light source in various locations to find the ideal location for the client.

• Try different visual fields to find the ideal one for the client.

• Allow for a good bit of time for the client to respond to what is being seen.

References

Cortical visual impairment pediatric visual diagnosis fact sheet. (1998). See Hear, 3(4). Retrieved  

      from: http://www.tsbvi.edu/seehear/fall98/cortical.htm

Macintyre-Beon et al. (2012). My voice heard: the journey of a young man with a cerebral visual

        impairment. Journal of Visual Impairment & Blindness 106(3) 166-176.

Philip, S. (2017). Setting up of a cerebral visual impairment clinic for children: challenges and

      future developments. Journal of Ophthalmology. Doi: 10.4103/0301-4738.202303

-Dana LaValley, Music Therapy Intern

Music Therapy and the Grieving Process

         Since the beginning of time music has shown its soothing effects. Take a look at David playing the harp for the King to help sooth his soul. Music can help heal a person who is grieving if the music is used in a structured therapeutic way.

         Grief has six stages that a person passes through. It is important to note that the stages may not go in the exact order as listed. Stage one is always denial. “Denial buys time needed to blunt the initial impact of the shattered dream.” (Moses, 2004) Most times a person is grieving the loss of a dream, whether it is the loss of a dream that you will have more time with the one you love or the loss of a dream you once had for yourself or someone you love. The next stage is anxiety; once a dream has been lost the person has to make a major life change. In today’s world the society makes anxiety an inappropriate response; however anxiety is an appropriate reaction to a major life change.  The next stage is fear; “fear is a warning that alarms the person to seriousness of the internal changes that are demanded.” (Moses, 2004) Fear is a common stage that comes along with anxiety; after feeling anxiety, fear of the unknown comes. Guilt is another state of grief. It is a normal feeling to feel guilty about the life you have. Guilt can be expressed because people believe that good things happen to good people and bad things happen to bad people. (Moses, 2004) The next stage is depression “characterized by profound and painful sobbing”. (Moses, 2004) The final stage is anger; the question “why me” is often asked during this state. This stage is typically directed toward one person.

Music therapy sessions can have structure while remaining open to the emotions and vulnerability of the person experiencing the grief. The music therapist can used many techniques as tools to help with the grieving process. Improvisation is a music therapy technique that has a small amount of structure but allows for a large amount of emotional expression. Songwriting is another music therapy technique; this technique can vary in structure. The therapist can take a song that already has a tune and replace the words with some that the client wants or the therapist can write an original song with the client. The therapist uses the existing relationship the client has with music, preferred music or favorite genres.

These techniques can help with anyone who is going through the grieving process such as: someone who lost a loved one, someone who lost the ability of a body part, or someone who has had a close family member receive a serious diagnosis. All of these scenarios have someone who has lost an idea of how their life would look and are going through the stages of grief. Music therapy can uses the stages of grief paired with music to help work through the stages in a non-threatening environment.  

                             -Dana LaValley, Music Therapy Intern

McFerran, K. (2011). Music Therapy with Bereaved Youth: Expressing Grief and Feeling  

       Better. Prevention Researcher, 18(3), 17-20.

Moses, K. (2004). Impact of childhood disability: the parents struggle. Pent Forum. Retrieved

       from: http://www.pent.ca.gov/beh/dis/parentstruggle_DK.pdf

Learning Through Play: The Greenspan Floortime Method

           Mark Greenspan developed a specific method of floortime therapy to interact with children with autism and developmental disabilities. It is all about meeting the child where they are and letting them guide the interaction between adult and child. There are six stages that Greenspan developed in order to aid development.

·      Stage 1: Self-regulation and Shared Attention

o   The child must be able to regulate in the environment in order to enter the world of shared attention with the adult.

o   The adult engages the child using hearing, touching, looking and movement.

·      Stage 2: Engagement and Relating

o   The adult interacts with the child and engages emotionally with them while they play encouraging pleasure they receive from the interaction.

o   Establishing relationships with the adult is important for the child to help support the development of motor planning, language, and positive attitudes towards learning.

·      Stage 3: Two-way Intentional Communication

o   This stage is where the child takes the lead and communicates wants, interests, and needs through exchanges with the adult.

·      Stage 4: Purposeful Complex Problem Solving Communication

o   The adult continues the communication from the child by going with the ideas they are presenting and following through on them (going to the door when the child leads you there and asking what they will go get).

·      Stage 5: Creating and Elaborating Symbols (ideas)

o   This stage focuses on playing with the child in a way that they can transfer later into the real world. Establishing relationships and fixing problems in play will later help them connect that to their life.

·      Stage 6: Building Bridges Between Symbols (ideas)

o   This is when the child is challenged to differentiate between different feelings, thoughts and actions. Creating play or a drama that has a beginning, middle, and end will help the child make sense of themes or ideas that may be fragmented.

In our music therapy sessions, we think about the levels of play in order to ensure the session has a good flow. Incorporating the floortime stages into our sessions can be beneficial to help guide our interactions with our clients to encourage success.

Source: Greenspan, S, & Wieder, S. (2003). Climbing the symbolic ladder in the DIR model through floor time/interactive play. The National Autistic Society: 7(4), pgs. 425-435. 

--Lauren Booke, Music Therapy Intern

Rhythm, Music, and The Brain

         I have been working my way through Dr. Michael Thaut’s book, “Rhythm, Music and The Brain.” While the book is quite academic in nature and focuses a lot on complex scientific findings, there are also universal music therapy concepts that can directly apply to everyday practice.

         Dr. Thaut has dedicated his research and music therapy practice to putting science behind the success of what music therapists’ witness with their patients every day. He has created the field of Neurologic Music Therapy and continues to train others in these science-based music therapy techniques. While a lot of his research is with patients who have suffered a stroke or have been diagnosed with Parkinson’s Disease, his findings can be applied across the board.

         Here are a couple of quotes from his book that really have stood out for me. I think it is so important as advocates for music therapy to learn from as many sources as possible about the field and research that is available to us.

        “Rhythm may be one of the central processors to optimize our gestalt formation in the basic processes of learning and perception.” (pg. 17)

o   A gestalt is a completed unit of human experience. So basically he is saying that rhythm can help our brain develop the tools we need to gain the processes of learning and perception.

·      “Artistic expression may exercise fundamental brain functions and may create unique patterns of perceptual input that the brain needs and cannot generate through other means in order to keep its sensory, motor, and cognitive operations at optimal levels of functioning.” (pg. 25)

o   One of the many reasons music therapy is such a beneficial treatment modality is because it has that unique artistic expression component that triggers the brain totally different than anything else.

·      “Music must be viewed as a biological fact, not just as a cultural phenomenon.” (pg. 57)

o   Human beings are innately musical and learning more how to utilize that to achieve growth is what music therapy is all about.

Through his research, Dr. Thaut has proven time and time again that there are unique benefits to using music in engaging, developing, and growing the potential of the human brain. These are just a few of many of his findings and the music therapy community is blessed to have him continuing to learn more about what we do each and every day. 

-Lauren Booke, Music Therapy Intern

North Fulton Family Life Magazine-Music Therapy & Literacy

Ms. Perry Wright's article on Music Therapy & Literacy was published in the North Fulton Family Life Magazine this month.

Click here to read the article!