Example Case CVI

ICF-Based Visual Profile: Case Example (Periventricular Leukomalacia)

Background

Alex is an 11-year-old boy diagnosed with periventricular leukomalacia (PVL). His parents and teachers have noticed he struggles with complex visual tasks and spatial orientation, prompting a comprehensive visual assessment within the ICF framework.

ICF-Based Visual Profile

Body Functions and Structures

  • Visual acuity: Within normal limits (6/6 or 20/20)
  • Visual field: Full peripheral field
  • Contrast sensitivity: Mildly reduced (log CS 1.5)
  • Color vision: Normal
  • Eye movements: Saccadic eye movements slightly impaired
  • Visual processing (b156): Significant deficits
    • Visual selective attention: Severely impaired
    • Visual-spatial perception: Moderately to severely impaired
    • Visual memory: Mildly impaired

Activities and Participation

Seeing and related functions (d110-d129)

  • Struggles with complex visual scenes and crowded environments (d110)
  • Difficulty maintaining attention on relevant visual information when distractors are present (d160)
  • Problems with visual search tasks, especially in cluttered environments (d110, d160)

Learning and applying knowledge (d130-d159)

  • Challenges in tasks requiring visual-spatial skills, such as geometry or map reading (d170)
  • Difficulty organizing information on a page or computer screen (d166)
  • Struggles with tasks requiring integration of multiple visual elements (d160, d170)

Communication (d310-d329)

  • Verbal communication skills are age-appropriate (d310-d329)
  • Difficulty interpreting complex visual social cues (d315)

Mobility (d450-d469)

  • Can navigate familiar environments well (egocentric coding intact) (d450)
  • Struggles with spatial orientation in new environments (allocentric coding impaired) (d460)
  • Difficulty with activities requiring depth perception and spatial judgment (d455)

Self-care and domestic life (d510-d650)

  • Independent in basic self-care but may take longer with tasks requiring visual-spatial skills (d510-d570)
  • Struggles with organizing personal space and belongings (d640)

Environmental Factors

Products and Technology (e110-e125)

  • Benefits from assistive technology for organizing visual information (+e130)
  • Uses simplified, high-contrast materials in learning environments (+e130)

Support and Relationships (e310-e320)

  • Receives support from family, teachers, and occupational therapist (+e310, +e330, +e355)
  • Peers sometimes misunderstand his visual processing difficulties (-e325)

Attitudes (e410-e425)

  • Family and school staff have a supportive, understanding attitude (+e410, +e430)
  • Some misconceptions exist about his capabilities due to normal visual acuity (-e460)

Services, Systems and Policies (e510-e595)

  • Receives specialized educational support and occupational therapy (+e585)
  • Limited community awareness of visual processing disorders (-e460)

Implications for Development and Support

  1. Educational Strategies:

    • Simplify visual presentations and reduce clutter in learning materials
    • Provide extra time for tasks involving visual search or spatial reasoning
    • Use verbal descriptions to supplement visual information
    • Break down complex visual-spatial tasks into smaller, manageable steps

  2. Attention and Information Processing:

    • Teach strategies for visual selective attention (e.g., systematic scanning techniques)
    • Provide tools and techniques for organizing visual information (e.g., color coding, mind mapping)
    • Encourage frequent breaks during visually demanding tasks

  3. Spatial Orientation and Mobility:

    • Provide explicit training in allocentric spatial coding
    • Use landmarks and verbal cues to support navigation in new environments
    • Practice spatial skills through guided activities and games

  4. Social Skills Development:

    • Explicitly teach interpretation of complex social cues
    • Provide structured social situations with clear visual organization

  5. Environmental Modifications:

    • Organize home and school environments to minimize visual clutter
    • Use clear, consistent organizational systems for belongings and materials
    • Ensure adequate lighting without glare

  6. Psychosocial Support:

    • Build self-advocacy skills, particularly in explaining his visual processing needs
    • Provide counseling to address frustrations and build confidence

  7. Family and Community Education:

    • Educate family, teachers, and peers about visual processing disorders
    • Advocate for awareness of "hidden" visual disabilities in the community

This ICF-based profile provides a comprehensive view of Alex's functioning, highlighting how his visual processing deficits, particularly in selective attention and allocentric spatial coding, impact various life domains. It serves as a foundation for developing targeted interventions that address his specific needs while leveraging his strengths, such as intact egocentric spatial coding and verbal skills.