Purpose Individuals with cortical visual impairment (CVI) can have difficulties with visual processing due to physical damage or atypical structures of visual pathways or visual processing centers in the brain. Many individuals with CVI have concomitant disabilities, including significant communication support needs; these individuals can benefit from augmentative and alternative communication (AAC). Because much AAC involves a visual channel, implementation of AAC must consider the unique visual processing skills and challenges in CVI. However, little is known empirically about how to best design AAC for individuals with CVI. This study examined processing of visual stimuli in four young adolescents with CVI. Method This study used a within-subjects experimental design that sought to provide an in-depth description of the visual engagement of individuals with CVI when viewing stimuli of various levels of complexity, either with or without a social cue. Results Participants engaged most with the simplest stimuli (relative to the size of those stimuli) and engaged more when a social cue was provided during the task. The level of engagement with more complex stimuli was related to participants' score on the CVI Range, a clinical assessment tool that characterizes level of visual functioning. Conclusions Implications for AAC include considerations for the internal complexity of AAC symbols and the complexity of the arrays created for individuals with CVI. Clinicians working with children with CVI who use AAC should consider the unique features of their visual processing.
Purpose: Many individuals with cortical visual impairment (CVI) are unable to meet their daily communication needs through natural speech. Augmentative and alternative communication (AAC) provides supports for individuals with complex communication needs, including those with CVI. However, many forms of AAC involve access via a visual modality. This presents specific challenges for assessment and intervention of individuals with CVI using AAC. Method: This study used an automated eye tracking technology to analyze the gaze patterns of one individual with CVI to stimuli of varying complexity. The automated eye tracking technology captured the point of gaze of the participant every 16 ms (60 Hz), allowing for a detailed evaluation of what captured the participant's attention. Results: Variations in stimulus complexity resulted in changes in visual attention. Overall, the participant engaged significantly faster to and longer with simpler images both when presented one at a time and also during a preferential looking task when two stimuli were presented. Additionally, one stimulus displayed a teddy bear, with an animated face. The participant gazed at the face for the majority of her looking time to that stimulus, rather than the colorful foot pads. Conclusions: The participant demonstrated clear patterns of quicker response times and longer gaze times when the stimuli were simpler in design. This has implications for AAC interventions and choice of symbols. Additionally, the participant's ability to engage with the face of the teddy bear image suggests her visual processing was consistent with the score she received on the CVI Range, an assessment tool that describes functional vision in individuals with CVI.
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