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The Yellow Smiley Face - By Laura Garcia and notes by Natalia Kelly, Orthoptist

We hope you and your families are staying safe and well during this time. While this is a challenging time for many of us, in our next blogs we would like to highlight some activities that you may find helpful while staying at home. In this blog, Laura explores Eva's first visual interaction with an iPad app.

The following post is adapted with permission from Laura Garcia's blog, "Adventures in Neuroplasticity".

The Yellow Smiley Face - Laura and Eva's story

I came across an app during the early days of Eva’s diagnosis which I finally baulked and purchased (yep, I am one of those people that tries to find free apps before purchasing!). Big Bang Pictures was the first app I purchased for Eva (about $30AUD); it features high contrast images and great sound effects designed to provide visual stimulation and help assess visual preferences. The user can make the images very simple to more complex, depending on the child’s needs. I found this app to be very useful when Eva was in Phase I on the CVI Assessment Range (I write about this in my first blog post here), where Eva was pretty much only noticing something bright in front of her, but had no idea what it was and was not focussing on it either. I would expose her to this app in a dark room, right after she woke from her nap but was still in her cot. I did this because 1) She couldn’t get away from me (She was crawling at that time), and 2) Right from waking, she would more than likely be less visually fatigued, rather than showing her after she had been playing.

When I placed the iPad in front of her for the first time, she didn’t look towards the iPad but reached out towards the yellow smiley face that appeared…success! I was beside myself with excitement, I thought to myself, “Surely Eva must have seen the yellow smiley face because she reached for it?!” I moved the iPad away from her and put it on the other side of the cot called her name from that side…she reached for it again! I did this a few times and she reached for it each time without fail. Her reaction time was slow (this is called visual latency), but the bright yellow smiley face did catch her attention time and time again. It was at that moment that I realised after all my theoretical research on CVI, that it was true, it was entirely possible that Eva could improve her vision.

Big Bang is a great introduction app as you can change the background and foreground colours and start with silhouette images, right down to images with more detail. It is a very simple app but very effective in engaging your little one who is just starting out their CVI journey. I feel it is definitely worth paying the money for as it will give your child a lot of visual stimulation. I would suggest transferring these iPad images onto print as well – so grab some black/white/coloured cardboard and preferably print the same images as in the app – and stick them on different coloured backgrounds and try and engage your child. Using Fluro coloured cardboard as the background would be very engaging as well. The reason why I believe the same information should be transferred from screen to paper is that we have noticed a huge difference between Eva being able to identify images on the screen to paper – she could easily identify shapes on the iPad, but having the exact same image on paper was difficult for her, she couldn’t do it at all. Transferring the same information during the same session worked for us very well and we found whichever medium she became stronger in, was what we started with and then we would move into getting her to work on the more difficult exercise: for us, iPad was easier for her so we did a warm up on the iPad and then moved the same exercise onto paper.

Good Luck with this exercise, I would love to hear if you have used this app (or something similar!) and how it has worked for you.

An Orthoptist's Perspective - by Natalia Kelly

Big Bang Pictures and other similar apps can assist individuals with CVI as the user can build the complexity of the visual image to meet the child's needs; starting with a high contrast silhouette figure (i.e. smiley face) to a more complex line art picture (i.e animated face with facial features).

It is likely that Eva initially looked towards the screen and then looked away, before reaching for it again. Although she may not have looked at the screen, she repeatedly and accurately reached toward the screen with the simple image each time without fail. When Eva looks to identify where an object is and then looks away, and then accurately reaches for what she saw, this is called optic ataxia. When someone is able to look and reach for an object at the same time, this is called visually guided reach. Over time, Eva has been developing her visually guided reach.

As Laura mentioned, another suggestion to consider when using iPad apps is transferring the app images onto print as well. This may help your child be able to transfer an electronic image to hardcopy/paper-based image. This strategy may also help your child visually engage with an image.

We would love to hear more about any apps or programs you have used to assist with aspects of CVI.

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