Children and Young People with CVI: Sensory Support through SENcastle Access

What is CVI, and how does it develop?

Cortical Visual Impairment (CVI) is an increasingly common form of visual impairment diagnosed in children. It occurs as a result of damage to brain structures responsible for visual perception. Unlike other types of visual impairments that involve damage to the eye itself or the optic nerve, in CVI, the eyes are anatomically intact. Still, the brain’s ability to interpret visual signals is weakened. Children with CVI may undergo a routine eye examination, but they are still unable to utilise their vision functionally. Early brain development, especially during the prenatal and perinatal period, is susceptible to hypoxic, ischemic, and traumatic injuries, which can cause changes in the visual cortices and pathways (Roman-Lantzy, 2018). Due to the increasing survival rates of children with neurological difficulties, CVI has become the leading cause of visual impairment in developed countries, which explains why professionals are giving it much more attention.

Characteristics and Challenges of Children with CVI

Children with CVI exhibit a wide range of functional patterns, which vary depending on the degree, location, and extent of brain damage. Some characteristic patterns include a preference for specific colours (for example, yellow or red), avoidance of complex scenes and displays, difficulty recognizing faces and objects, and reliance on the periphery of the visual field (Dutton & Bax, 2010). These children may respond better to moving objects, simple visual backgrounds, and materials that are presented in a repetitive and consistent manner. A particular challenge lies in the fact that their ability to use vision can fluctuate throughout the day, depending on factors such as tiredness, the lighting in the room, and the level of environmental stimulation. Therefore, continuous monitoring, evaluation, and individualization of the approach for each child are essential.

CVI and Comorbid Conditions

CVI very often occurs as part of more complex neurological conditions. Children born before the 32nd week of gestation, with low birth weight, or with perinatal complications such as intraventricular haemorrhage and hypoxic-ischemic encephalopathy are particularly at risk (Good et al., 2001). CVI is also present in children diagnosed with cerebral palsy, epilepsy, hydrocephalus, or genetic syndromes such as periventricular leukomalacia or West syndrome. Additionally, there is an increasing incidence among children with autism spectrum disorder (ASD), which further confirms the complex relationship between sensory integration and visual processing. Precisely because of this type of comorbidity, an interdisciplinary approach is essential—not only in diagnosis but also in the subsequent planning and implementation of interventions, which will undoubtedly include therapeutic work focused on the child’s vision and visual abilities.

The Need for Targeted Sensory Input

For children with CVI, traditional visual stimulation is often not sufficient to stimulate the development of perception and cognitive skills. Therefore, it is crucial to include other sensory systems in therapeutic and educational activities—particularly the auditory, tactile, vestibular, and proprioceptive systems. Multisensory stimulation must be structured, targeted, and carefully planned, as excessive stimulation can cause confusion and withdrawal from the activity itself. Children with CVI often respond better when stimuli are presented one at a time, with sufficient time allowed for processing and visual interpretation. Therapeutic interventions that combine light, sound, vibration, and tactile input can encourage functional use of vision through the brain’s neuroplasticity (Hyvärinen, 2000).

Multisensory Rooms and CVI

Multisensory rooms, also known as sensory rooms, with their rich and diverse sensory input, offer numerous opportunities for stimulating and regulating children with CVI. However, their effectiveness depends on the level of adaptability to each user's needs. Standard multisensory equipment can often be visually too complex, with light effects and reflections that confuse children with CVI, leading to overstimulation. Key adaptations include the use of simple, single-coloured backgrounds, the avoidance of mirrored surfaces, the application of high-contrast lighting, and pairing stimuli with tactile or auditory responses. Additionally, the room must allow for the controlled presentation of stimuli—preferably one at a time. The use of technology that enables children to interact actively, rather than remain passive, adds further value by fostering a sense of control and motivation in them (Lueck & Dutton, 2015).

Introducing SENcastle Access

SENcastle Access is an accessible version of the SENcastle multisensory system, specifically designed for children and young people who use wheelchairs and have multiple developmental difficulties. The device is intended to be positioned on a table, allowing a wheelchair user to approach as closely as possible and independently explore the unit's interior. This model provides control through standard switches or by using eye-gaze technology. In this way, active participation is enabled even for users who cannot rely on traditional access methods, such as those who use AAC devices. SENcastle Access offers a multisensory experience enhanced with visual and auditory sensory scenes, which can be further complemented by utilising the tactile house-shaped pillow and the vibration pillow. SENcastle Access introduces a new level of inclusivity in working with children who have complex developmental challenges.

Adaptations of SENcastle Access for Children with CVI

One of the key advantages of SENcastle Access for children with CVI is the fact that it provides a sensory-rich yet visually simplified environment. The single-colored base and inner floor reduce visual complexity, making it easier for the child to focus on the primary source of stimulation—the light column and the five colored buttons that need to be pressed on the base. Using control cards, the LED light can be adjusted to display colour intensities that children with CVI can detect more easily and perceive more effectively. Furthermore, the ability to activate different sounds through single-coloured buttons or additional switches, in combination with sensory pillows, enables the multisensory processing of stimuli, which is crucial for developing connections between vision and other sensory systems (Roman-Lantzy, 2018). SENcastle Access is exceptionally well-suited for implementing individual therapeutic goals in a controlled and motivating environment.

The Importance of Assistive Technology

Children and young people with CVI represent a highly vulnerable group that requires an individualised, yet flexible and inclusive approach. Accessibility, such as that provided by SENcastle Access, creates the conditions for active participation in sensory and planned activities, despite the presence of multiple difficulties. This technology acknowledges the importance of visual simplicity, alternative access methods, and multisensory stimulation. The use of SENcastle Access can be an integral part of a therapeutic plan that promotes the development of visual attention, emotional regulation, and a sense of control over one’s environment. Ultimately, such innovations support greater inclusion and an improved quality of life for children with CVI and their families.

References:

1. Dutton, G. N., & Bax, M. (2010): Visual Impairment in Children Due to Damage to the Brain. Mac Keith Press.

2. Good, W. V., Jan, J. E., DeSa, L., Barkovich, A. J., Groenveld, M., & Hoyt, C. S. (2001): Cortical visual impairment in children. Survey of Ophthalmology, 45, 5, 379–408.

3. Hyvärinen, L. (2000): Visual functioning and rehabilitation of children with cortical visual impairment. Journal of Visual Impairment & Blindness, 94, 10, 677–689.

4. Lueck, A. H., & Dutton, G. N. (2015):Vision and the Brain: Understanding Cerebral Visual Impairment in Children. AFB Press.

5. Roman-Lantzy, C. (2018): Cortical Visual Impairment: An Approach to Assessment and Intervention (2nd ed.). American Foundation for the Blind.