When The CVI Range Score Doesn’t Change

A couple of years ago I had a major wake-up call.  I listened to a parent conduct a session at a CVI conference.  During her talk, she mentioned the importance of The CVI Range scores and the expectation that they will continue to improve over time.   And then this mom, who I have always viewed as a pillar of fortitude, stated that at one of her daughter’s Pediatric VIEW appointments, I reported that her daughter’s CVI Range score had remained the same as when I previously evaluated her.  I then heard this CVI mom tell the attentive group of parents and providers that because of the unchanged score she cried all the way home, several states away.  At that moment, I sharply realized the investment parents have in the results of The CVI Range assessments and the potential for either elation in improvements or devastation when the results do not reveal a positive change.

I think I have not done a very good job of explaining the potential meanings of CVI Range scores that seem “stuck”.  I have not done a very good job of describing that it is not a failure or a sign that a child has reached their potential.   There are many, many factors that may contribute to a CVI Range score that does not increase over two or more evaluations.  Some of the factors have no solutions-they are a reflection of conditions that are internal to the child.  Others clearly can be resolved and are outside the student. Both types of factors may include:

  • a change in medication or overall health status (such as an increase in seizures or a new seizure diagnosis)
  • an individual being in high Phase II or Phase III in which skills and functions improve but the number value (7-10) may not
  • normal physiologic changes such a puberty
  • changes in school personnel or placement that impact a child’s sense of well being and participation

I also need to describe some other reasons The CVI Range score may not change.  These are considerations should result in a call to action and are within the control of educational and therapeutic team members.  They are factors outside the child/student and are more a reflection of the environment, the knowledge & skills of the providers, and a level of dedication to a CVI Range approach.  These reasons may include:

  • CVI adaptations are associated with “vision time” rather than an approach that spans the day
  • CVI approaches are vague and random rather than being derived precisely from a CVI Range score
  • an environment that rarely provides the sensory support needed for the student to use vision rather than hearing or tactile exploration
  • the results of a learning media assessment that indicates the use of non-visual learning for literacy
  •  a CVI Range approach in place at home that is not aligned with the approaches used in school
  • the vision providers use an approach that is rooted in the principles of ocular visual impairment
  • CVI Range evaluators who may not be testing reliably

One of the key purposes of The CVI Range is to be fully aware of the status of the scores over time and to intervene when there is a plateau. CVI Range scores that do not change should never be taken casually and can provide an opportunity for family and school members to examine the student’s program and reassert their efforts.   And for all of us who provide therapy services, evaluation, or education, we must never underestimate the impact of progress on the student but also on their parents who wear their children’s heart on their own heart each moment of the day.