 Well, good afternoon, everyone. This is Roy McConnell here. Welcome to everyone. Just like last month, we've got a significant number of folks who have tuned in for webinar number two with Dr. Christine Roman. We're thrilled to have Dr. Roman with us again. And we did the introduction last time. So what we will do this time is just get rolling. So I'm going to turn it over to Dr. Roman and look forward to the next hour. If you have questions, please either raise your hand or you can put them into the into the chat. And I'll alert Dr. Roman to some of those questions. So welcome, Dr. Roman. Hi. Hi, everyone. Thank you for joining today. I imagine you guys have snow like we do. It's quite a winter and it's kind of fun to cozy in, but glad that we're all together. So, you know, this virtual way, I'm going to talk a little bit about about. I'm going to try to talk about there we go about literacy today. And I want to talk about literacy in a way that's pretty broad initially, because the United Nations Educational Scientific and Cultural Organization UNESCO defines literacy as the ability to identify, understand, interpret, create, communicate, compute and use printed and written materials associated with varying context. Literacy involves a continuum of learning and enabling individuals to achieve their goals to develop their knowledge and potential. And here comes the critical part and to participate fully in their community and wider society. So the National Institute for Literacy, and this needs to be updated, but in 2009, they talked about one of the predictors for literacy is being able to see the similarities and differences between visual symbols. So anybody who's working with a CBI on a communication device, anybody who's asking children to make choices, anybody who's asking kids to identify some detail is actually doing this. This really speaks to the CBI characteristic of complexity specifically, salient visual features. And we'll talk more about that. Or another thing they said was being able to pick out a picture of a stop sign from among a set of pictures, including other road signs with other shapes. So in other words, for kids with CBI, this includes issues like complexity of array and other elements. So then what is literacy for students with CBI? Coming straight from those two definitions, it is using all senses to gather information that support the students' ability to interpret and utilize information. It is integrating the information to participate in the community and wider society, and providing access to information in the visual world to facilitate the development of schemes and concepts. In other words, the traditional definitions for literacy actually clearly apply also to the population of kids with CBI. I want to just take a moment and say that when I first started working with children with CBI, I really never considered the concept of literacy because it seems so remote. It just seemed like all I was trying to really help the child do was maybe have some way to interact with a target, with an object. And as I remember this threshold moment when a parent asked me, when I asked them, tell me what your goals are for your child. Now, this child has CBI, has spastic quadriplegia, has really no usable expressive language in traditional ways. He has seizures. He's kind of like a lot of students we see. And this mom said, well, my goal is that Matthew would learn to read. And it was the moment that kind of cemented me where I was in place because I thought, well, that isn't going to happen. And yet everything in my being tells me that we should pay attention to what parents want, what's important to them, the mission, the goals they have for their child. So I thought, well, let's just move in that direction. And in doing so, I began to really think very seriously about literacy for children with CBI. And I have to say that today I can't imagine a child for whom I would participate in an IEP who wouldn't have something about literacy. And I've been shocked to see how many children actually learn to read. Okay, I'm getting an echo now, but no, no, it stopped. Okay. So who are these individuals with CBI? They stand, as you know, all ability and disability levels. However, their cognitive potential is unknown until they have access to information. So I think it's very important that we not, well, I personally believe that it's not helpful to compare children with CBI to their somehow arbitrary developmental age, because I find that that is, those developmental ages are based on typically developing children. It's not helpful. And sometimes it puts a ceiling on what people expect of children with CBI. Remember, too, that motor ability is the weakest indicator of cognition and receptive language is a very close indicator of cognition. So we're going to, as, you know, we progress to this, I'm going to be talking a lot about, you know, scores that someone gets on the CBI range. And as you just said, you know, a brief, I'm going to go through these very, very quickly, you know, there are three phases. And there's a child in phase one. And so I'll move on. Okay, those are those, you know, the children who have to be in a dark room, left in an object that always has movement that have to be, that aren't really expect to reach or swap, but mostly use, you know, visual attention to just attend to something. In phase two, the child scores above three, it's only not four, they score above three to seven, that's, I don't know where, who made that slide. And in phase three, they score above seven to 10. The issues of children in phase three, CBI are very particular and very challenging. And we're, we'll talk a little bit about that as we move to you, but we're primarily focusing on kids who are in early phase two. I'm going to pass all that along. And phase three. So what, what could be happening to these kids with CBI, what happens in their brains that, that, you know, allow, what allowed Matthew to ultimately learn to read what, what happens, what happens as the child progresses from phase one to phase three? Well, here's the problem. Since the CBI are exposed to visual stimuli, and their question is then why don't they automatically improve or resolve the visual functions? They're in the visual world. Why don't they benefit from it like babies do? Well, they just, you know, and they also don't benefit from the approaches used by kids with eye disorders. I'm going to pass over this to them. So I'm, we only have an hour and there's a lot of this that is, oh, this is just for fun. You want to see this? This is the child in phase three of CBI. Okay. So the real, the issue really, there is a point to this. And the point is this, that, that little boy actually that you saw there started out in phase one. He is a micro, was a micro preemie. He has cerebral palsy. He has seizures. He has, you know, significant CBI. He is now in phase three. How did that happen? Well, it happens because of the last bullet point on this slide that when, you know, when neurons develop, they, they kind of multiply, they migrate out into the brain and then they get organized. And so the proliferation part happens before the baby's born. The migration part is the neurons move out into the brain. They form specific patterns and kind of associated with the shape of the brain. The organization is where those neurons specify for particular functions. This is where, this is where we come into the picture at this organization level where we engineer the environment, the use of materials. We engineer how things are going to be presented to a child in order to help the child look and look meaningfully so that those neurons are actually fired up and connecting to other neurons to create organization for new vision. It does not happen in a vacuum and it's not really associated with just the passage of time. So it, it seems very clear that there is something we have to do to get that to happen. And so this little guy that you see here on the slide that was dancing and has a little bit of stigmatism. That's why he's wearing glasses. He, he actually went, you know, through all the stages of the CBI range. And at this point now, even though no one had a clue and his parents were told really dreadful things by the physicians about his outcomes, what he would turn out to be, he is quite a gifted reader. And again, you know, he's that child who benefited from literacy approaches. I always like to show this, this slide because I like to actually picture this when they watch the child actually land, you know, sort of visually align their attention with a target. It reminds me of this picture in which those, the neurons fire up and the axons, those, those straight parts that look like, you know, they're like branching out away from the neuron, they reach out to connect up with other neurons. And if they reach out and connect up with enough additional neurons, they will then, you know, create a, a function, a pathway, and that pathway hopefully will become a function. This happens because of what we do, what we do or fail to do. I mean, this happens because of what we do. And if we fail to do it, the neurons are likely to remain disorganized and not connected. So what is this, what is this neuronal organization? So around six months of age, there's the greatest, there's the greatest amount of synaptic connections. And there's all this branching, branching, branching out of those neurons trying to connect up with other neurons to create a function. And then there's a pruning period in which the ones that are most functional are selected and strengthened. But if they're not used, they're pruned away. The organization process continues up until and likely beyond puberty into the early 20s. Who knows, we may learn in five years that it goes on even longer than that. So this is really when we talk about this, we're really talking about plasticity, plasticity of the neuroplasticity. And so, let's see here. So these new neurons that are recruited to become visual functions. And again, they're not recruited just because the child became, went from one year to three years of age. It really had everything to do. Those neurons can't really be fired up unless it happens through the eyes. And how, what helps the child really attend visually, all the things around the characteristics. Okay. So I'm going to actually, I want to skip out of this for a minute because I want to skip ahead to some of the, oh boy, if I can do it. I want to skip ahead since we only have an hour. Some of the things that dovetail most consistently with literacy. Okay. So I want to talk now. I'm going to skip ahead to this for the purposes of time. And I want to mention the prerequisites to literacy for children with CVI. This is new information. I think I've only presented this maybe one other time. And it is something that I've been working on and thinking about for a long time. And so we know, you guys all know about ventral stream and dorsal stream vision, right? So dorsal stream is the wear system. And it helps us notice movement, light, color, form, some color. And dorsal stream vision is low acuity vision. So obviously the child's going to access literacy, they're going to need to develop more ventral stream vision. Ventral stream vision being the what system. And it is best manifested through eye to object contact. You see the child, you can almost draw an imaginary line between the child's eye and the place, the target they're looking at. So if a child's just looking to the left, but notices something with their peripheral vision and reaches for it, that's probably a dorsal stream response. A ventral stream response would be even if the child's head is tilted a bit, you see them trying to align their eye with a target to access more detail to figure out what it is. You can't tell the difference between the D and the B. You can't tell the difference between a symbol for eat and drink. You can't tell the difference between the word cat and cap without ventral stream vision. The second prerequisite that we'll talk about is the ability to identify salient features, which we'll talk about in depth. That's that ability to really know what parts of something you're looking at are most salient and sort of define that target. And the third is comparative thought, the ability to think about two things at once and think about how they're similar and not similar. So let's go through those. I think this is an important picture in that it is a picture of a little boy reaching in this bowl for these balls. And this is a classic example of a child using dorsal stream vision. You see how he's not really looking at the target, and parents will say, well, how do I know he sees it? Like, how does he even know it's there? But he always seems to get his hand where it belongs. This is the great gift of dorsal stream vision. It helps us know where something is. But this same child under a different condition shows us ventral stream vision, where you can see you can almost draw a little imaginary line from his eye to the target. What's the difference? Let's go back. What does the environment look like there? The environment is really normal. It's, you know, I'm wearing black, but there's nothing else adapted. In this situation, the room lights are off. He's surrounded by a gray wall. There's no pattern next to him or ahead of him. Light is used, color is used, and movement will be used. So by changing the environment, I can elicit a ventral stream response. Very, very important to try to get as much ventral stream function as possible. Children don't get higher than about four on the range if they don't begin to show us that detailed vision more and more. And so how do we do that? How do we get those neurons to fire up and connect for vision in favor of ventral stream function? It's by creating activities, environments, adaptations that help the child do this. So, again, a couple things to help elicit ventral stream vision. We want the child to use eye to object contact and remember that vision should precede the action. What do I mean by that? Well, if you could see me, I would show you something right now, but I want you to imagine that you're offering a child a cup or you're offering them a bite of food on a spoon. And the spoon is maybe fluorescent pink, hot pink. Sometimes it's, you know, maybe during feeding, the what you're really going for is the child, you know, eats, they eat their food or maybe you want them to sometimes pick up the spoon or help feed. What I'm going to ask is that you put the spoon somewhere or in some way that the child has to look for the spoon before they get another bite or before they have the spoon in their hand. So in other words, if the spoon, I'll tell you an example, there's a little girl I was watching who she was doing a feeding routine and she had the spoon next to her bowl and she was facing a black background and that seemed fine. But she knew she had memorized that the spoon is always to the right of her bowl. So she was just kind of staring straight ahead and she would, you know, maybe with her peripheral vision, see kind of where the spoon was or just memorized it, pick the spoon up, you know, scoop some food somehow, get some help, put it in her mouth. I finally said to the person who was feeding her the next time, put the spoon somewhere else, don't put it in the same spot. And the paraprofessional said, well, she's going to freak out. She won't like that at all. And I suggested that we do it anyway because I wanted her to use vision to drive this little action. So she reached down for the spoon. It wasn't there. She got fussy. I begged the paraprofessional not to do anything just to wait for a moment. And pretty soon, Emma, in her frustration, quieted for just a moment, looked with eye-to-object contact, located the spoon, and then began to scoop. From that point on, I asked that the spoon be in a little bit of a different position each time, sometimes the right, sometimes above the bowl, sometimes next to the bowl, so that she would realize that she needed to look first. If I'm offering a child a target, let's say we're doing a center-based activity or a circle-time activity and there's a switch. And the child activates the switch to say good morning or what have you. If the switch is adapted correctly to the child's CBI, my suggestion is that you wait till the child looks. Even if they look away because of the visual motor characteristic, vision should begin that action before they swat. If they just swat out in space without looking toward the target with eye-to-object contact, I would literally move that target so that it would really require them to look. Does that make sense? And it doesn't have to be done punitively. It should just be done sort of naturally and normally because you'll see very quickly, much faster than it takes me to say this, the child will kind of reorganize and think, well, it's not there. Where did it go? And then they look. Okay, so this activates neuronal activity for ventral stream and also allows access to details such as salient features. So we want to use things like light and color and movement and changing the environment to help support ventral stream vision. We also want to integrate some methods that require the child to use eye-to-object contact and have vision precede the action. So what are salient features? These are the defining elements of an object, a target, or an action. These features are often not directly taught to typically sighted children. They happen kind of incidentally and they emerge as part of that incidental or learning and are supported by things like novelty, joint attention, and imitation. So for a child who's typically developing, they notice something that they've never noticed before. We'll talk about each of these briefly. And somebody talks about it and joint attention. There's a shared attention on a target and imitation. The child watches what someone else does and they begin to learn about some of these defining elements. Here's a picture that shows sort of the easiest way to define salient features. So you see here that this is a picture of an elephant. Maybe this is on an iPad with backlighting. And if I talk to the child, I'm going to say, so we're talking about a story today about Mr. Elephant. Remember, the elephant has a nose that's very long. It's called a trunk and I would highlight that with color. Or if the child is capable, I'd have them do that with me. I would import this into a drawing program and we'd do it together. You could take a picture onto a lightbox and do it with a marker, bingo dauber, or anything. Elephants also have giant flapping ears. Look, there's that giant ear and I would outline that. Why do I outline it? Well, I do it because color is an anchor. It draws and holds the child's attention. So I want to use color to try to encourage the child to look at the thing I'm describing. There are ways then I'm going to generalize that and do some other things. But salient features are without a child knowing that a cat is an animal that has pointy ears and whiskers, then maybe the best the child can do is just memorize one picture of a cat. That's not the same as knowing how to problem solve by looking at what a cat is. So we pair, even as a child, very, very young. Even before, you know, if they're baby, I still suggest that parents use language that has a couple salient features in it as you're talking about something that surrounds the child that the child's encountering. Because it can start to set up a sort of a receptive language repertoire for the child who's later going to look for those salient features. Okay. Letters have salient features, numbers have salient features, certain environments have salient features. How do I know, how do I know, for example, that I'm at a gas station and not a bank? There's salient features to everything all around us. Novelty is one of the things that can be a very big challenge, of course, for kids at CVI. It's one of the characteristics. And it allows us to sort of alert to the most discrepant target around us, something that is not in place, something unusual. But kids at CVI have a counterintuitive response to novelty. They tend to look at things they've seen over and over and over, because those are the things that make sense to them. Those are the things that are logged into their visual memory. Those are the things that have been separated from the visual kaleidoscope that they can't interpret otherwise. So we know that, again, think about that child who's thought to be so cognitively impaired, that their exposure, their ability to really gather information about new things is extremely challenging. So again, salient features can really help a child with that, and we'll get to this in a minute. And I just want to mention that when someone don't show visual curiosity, it should not be considered the same as a lack of potential or lack of interest or lack of, excuse me, or lack of cognition. Sorry. Okay. So I'm going to go back to that. So when we look at this picture, there's supposed to be two pictures here. We look at this picture. This is a novel picture. I imagine most of you have not seen this before. And for just a moment, for just a moment, you might think it's something to do with a bicycle, right? If you stand back from it and just kind of look, you think you're maybe seeing something, some part, some, maybe just a bicycle, because the salient features those fiddlehead ferns, those ferns that are unwrapping, unfolding become, they look like the wheels of tires. Okay. If we look at part of the body of that praying mantis, I think it is, it almost looks like there's a seat between them. How do you know it's not? How do you know it's not a bicycle? You know it's not a bicycle because of comparative thought, which we'll get to in a minute. And we, I think you guys have mostly seen this. This is another thing where, if I show you this novel image, you know, you have to try to imagine what it is. And your brain goes searching, searching, searching through everything that you could possibly, that would be a touch point with this to, you know, information about color, about animals, about faces, about the background being green until you finally come up with a best solution to what it is. But I ask you, what if your child was CVI and your visual schemes, your reference library is very, very small? You know, Elmo and Clifford and the red pom-pom and maybe four other things does not allow you to make very many inferences about what something is. It is salient features that tells us that this could be a bike. It looks so much like a bike, but there are other salient features that tell us not quite. So, so we have to intentionally teach children about salient features. And this is going down that path of literacy. So remember first ventral steam vision, that eye to object contact, that the ability to identify the defining features of something. And we might have to use light and color and movement to help us see those. It's also important to talk here about how joint attention helps typically developing children get much more information from their world that supports the development of these visual schemes. So one person looks at something, this is how children, you know, to a great extent learn language, they look at something their parent or someone notices them looking and then they expand on it. They talk about it. But what if you don't notice something? What if you're that child who doesn't notice, they don't, you don't direct your visual attention to a novel target? Well, people don't talk to you about any of it because it's not on your radar. So it's not on the parent's radar either. That you can see how it's such a slippery slope of a child appearing to be cognitively significantly impaired when actually they just don't have access to much information. CBI is really a disability of deprivation in many ways. Add to that the child who can't move on their own. And now we have even less information that the child enters their awareness. Imitation is a phase three thing for children with CBI, extremely hard to learn from imitation. So again, that really slows down. It really affects the way a child can learn the concepts and social skills for sure. So when we get back to this concept of salient features that were supported by, I just want to go back to joint attention for a minute. So with joint attention is the child notices something, an adult notices them noticing, and then they talk about it. Let's do an example. So the child is maybe in their car seat in the car, this typically developing child, and they look out the window and they say dog, and the parent looks at what they're looking at. Hopefully they're not driving. They look at what their child's looking at, and they say, oh, oh, honey, that is an animal. Yep, it has four legs like a dog. And it has a tail and has like furry stuff all over it. But this one has really tall legs and a long neck with hair on it called a mane. That's a horse. All of that rich language that came to the child started with the child noticing something. The parent then describes the salient features and uses comparative language of how the thing the child sees kind of makes sense, but let me clarify for you how these two things are alike and different. So salient features will require direct instruction. This is something that we can't just leave to chance. This is one of the few areas that a teacher of the visually impaired can write as a goal for the child as an IEP goal or an instructional goal in which we are going to actually teach and count how many targets we can teach and we can help this child understand how salient features so that maybe we would start with what I often put in an IEP, the child will learn 100 in a year. This doesn't go on forever because a child learns how to figure it out themselves after a while. Let's say the child doesn't talk. And so we're going to test to see whether you have a stable sense of what a cat is. So I teach you and I highlight the ears of the cat and I highlight the whiskers of the cat. I show you lots of different images of cat on the iPad. I do everything to help generalize it. Well, gee, I wonder if a tiger could be a cat. And we talk about these salient features until we really have it pretty cold. Then I lay out a series of images depending upon how many the child can handle at once or I show them sequentially like on the iPad. I just scan through them. And I'll say to the child, let me know using your switch, using your voice, using your device. Let me know when I show you one if it's a cat or not a cat. And that will help me know whether the child is really attending to what those salient features are. Because this again, I'm driving home that thing that Matthew's mother asked me, which is, will you teach my child to read? And I thought if I take the elements apart, I know there are three really critical elements and this is one of them. So you're not only going to facilitate the development of ventral stream vision by having the child look at that detail, but you're going to actually help the child realize that the world isn't full of 25 million individual pieces of information that have nothing to do with each other. They're actually very interconnected. And that the way I know what I'm looking at is that I look for and identify salient features. These will help the child solve novel visual problems. So if the child can tell from that array or those sequential, you know, images going by, some of which are cats gets them right. I know that this child is on their way to being able to look at any image of cat and have it. This becomes ultimately a metacognitive strategy. And you might think I'm talking about some genius child with CVI. Metacognition can occur in lots of different ways with lots of kinds of kids. And remember, we don't really know the cognitive ability of most of the students we work with. So what we're hoping is that the child will actually think about their thinking. They will actually pause and look at something, scan through their own reference library, their Google search until something matches, just like you looked at that very novel picture of that tree trunk thing. And to try to figure out what it was, that's what children with CVI have to do all day long. And it's made so much easier when they know that they're looking at something that matches their reference library. They can get the solution so much faster. So if the child looks at these objects, you know, how did they, it happened yesterday actually at clinic, I was very impressed with this little boy actually from Canada. So you probably know him, because you know, Canada's a pretty small place. And we're all, and I'm coming there, I'm just telling you, every day I get closer, that if this child actually was very, very, very impressive to see that he was able to tell me that that fox was not a dog. And I gave him a big bin of animals and I said, let's put all, find all the dogs in here and let's put them in this little box. And when he got to the fox, he really paused and really, really thought about it. So I got that German shepherd animal out and I held them side by side. And he said, and his little boy can talk, which is not usual, but he could talk. And he said, Oh, it's the tail. And they said, yes, it is. That's excellent. That little boy, his mom's goal is that he learned to read. And I know he can, he just needs a different system, which we'll talk about in a minute. So if you know for a child is doing a different kind of task or a much younger child, if they know that Elmo, if it's stable in their mind, that Elmo is red and has big googly eyes, and then it doesn't matter what position Elmo's in, right. And so we want to, again, we want to go from the realistic picture. We don't want to start with this stylized picture. We want to start with realistic images to the greatest extent possible, but we want to work toward those stylized ones over time. And if the child can do both, they know salient features. So there is a, there is a little activity designed by a gentleman named Matt Teigen who came up with a picture inventory. You can do this yourself. And what he did was he pre-tested kids about what they thought they were seeing. And he wrote down what they said, and then he taught children a whole, he taught these kids at CVI about salient features. And I don't know, I think he did it at six months and 12 months later. He, the kids were never allowed to see the testing pictures. Then he got out the testing pictures and retested the kids, and he found that, you know, once they understood the concept of salient features, they could identify things that were much more stylized, much more kind of comic book-like, all kinds of generalized versions of that same thing. But it has to start with the child getting a sense of, I need to, I'm looking for something. Now, what is it I'm looking for here? What do I see that tells me what that is? Okay, you get the idea here. And this is not really a story box. This is really a way to take some things from the page and help the child get a better sense of the salient features if they can't see it on the page per se. Excuse me. Pretty, I would have to say if a child could look at this book and without being told what the story was about, tell me that that was some kind of cat, I would say there's no reason you can't read, because that's a lot of gymnastics going on in your mind about salient features. So they help add critical information to that search engine or, you know, that reference library about what are the keys that unlock the mystery of what I'm looking at. It helps expand understanding, generalize learning, because again, if you know that tiger, you pretty much generalize what cat is. It supports understanding of the critical or defining features, and it helps with divergent thinking. So these are kids who don't have to have everything be the same every time, because that now can have the flexible possibility of something being similar, though not exactly the same. Let's see if I do a video. This is a picture of a fawn. A little boy's grandpa took a picture of this, and I don't really know if we have time to do this, but I'm going to show at least a part of it. A little boy's name is Griffin, and Griffin's siblings were shown the picture, and everyone thought it was so adorable. This little fawn was sleeping under the tree in the backyard. They showed it to Griffin, but he didn't hear any of the previous conversations. Griffin has CVI now, and it's kind of hard to watch this because he really struggles with this, but have a look. See if I can get it complete, and let me know if he can't hear it. Come with that isn't that picture. No, that is not an option to sit there and say, I don't know. Look at the picture, you can zoom in on it. Look at the picture and tell me what it is. Look at it. Take some guesses. This is where I just want to say something here. This is where when the dad says no, it's not a chipmunk. No, it's not a squirrel. This is a place where you would insert comparative language where you would say, well, it's like a squirrel because it's also an animal and brown, it's like a chipmunk because it's brown and has spots. But this animal, see how you would use that comparative language. So let's go. I'll move it up here. You look at it. Take some guesses. Take some guesses as you look at it. Hold on here. I'm going to zoom it up a little bit. There you go. Look at it now. You hear the mom in the background saying, use the salient features. I'm going to move on because what I want to say about that, it's kind of hard to watch. Eventually Griffin gets it. Eventually he gets it. But his dad has to talk to him about the salient features and about, he finally, he gets it. It's a deer. And then they kind of persist a little further that it's a baby deer. You can see the frustration. You can see Griffin's reluctance. You can see how he wants to avoid this. It's very, very hard. And so imagine you looking at a kaleidoscope and it feels like everybody else in the world can see what's in that picture. But all you see is a kaleidoscope. It's extremely frustrating. But the salient features are what finally got him there. Now, you might be surprised to know that the Griffin is a gifted reader. He is like the little boy that was dancing. Those are the two maybe highest reading kids I know with CVI. And it's so important to know that it is that even when a child can discriminate words and letters, those symbols stay fairly consistent. They're stable. But images change constantly. They're never quite the same. So that child who can even crack the code for literacy is not out of the woods when it comes to salient features of other things. So let's talk about comparative thought. This allows information. This is that third prerequisite. It allows information to be processed in terms of similarities and differences. And it is one of the foundations of literacy for sure. It's dependent upon the ability to detect salient features and to consider classes of information. So this little boy is he has CVI. When I saw him sitting in his high chair having his dessert items, I watched he just spontaneously sorted them into this little group these groupings. And I was able to say to his dad, I think someday this boy will read and he does because he spontaneously could compare how these things belong together. That's pretty darn good. I'm going to pass all that. These are just vehicles that share. So these are things that share traits, right? So we think about comparative language, right? And we think about okay, these are all different animals. What do they have in common? Well, if let's say, just like with Griffin and the chipmunks, thinking the chipmunk or the squirrel could be the fawn, if let's say a child looks at, let's say they look at the picture of the goat and they say cow. This is where I might say well. So I'm not going to tell the child they're wrong. I'm going to try to get behind their thinking. I'm going to try to think about it from their point of view. And I may say, well, it's like, what did I ask them to find the cow, right? So it's like a cow because it's an animal and it's got fur all over its body. And both of these animals actually have horns. Look at the goats, you know, are tall and curved. And the cows are kind of much, much shorter. Also a cow is a much bigger fatter animal. And a goat is much shorter. I might talk about the shape of the face. I'm not going to talk about mood, you know, like the sounds that they make, because those are not feeling it visual features. If I wanted to talk just about the horns, like the, I might highlight those with color. If I wanted to talk about how the nose on the cow, like saw a pig is a great one to highlight the pig's face, the nose, because that snout is very distinctive. And so it's really, really, really important to think about not even if a child gets the answer right. So let's say to tell you say, tell me what you see here. And they can, you know, or you say, show me where the giraffe is, and they can swat at that or touch it or use eye gaze to tell you it's there. It's still very important to reinforce to the child, except for in that testing part, to reinforce them. Yes, you're right, it's a giraffe, it's that animal with a really the longest neck of any animal. And it has those dark brown spots on its body, dark brown spots on its beige body or however you want to describe it. But what you need to do is ask yourself how you know it, and then try to find a way to put that into some pretty straightforward language. That ability to compare things is so, so, so important. That's just the family of that little boy who those materials belong to. I'm going to go past this. I'm going to go past the neurons too. So let's talk about the progression of how we get, if a child can show us that they have comparative thought. So if I say, if I go back to that series of pictures, and I had some things in it that didn't have parents, I had a dog and a cat, show me all the things in this picture that have horns. So that we're working on comparative thoughts. So I'm going to, I'm going to skip ahead again for a minute, because I want to get in the time that we have at 616. I want you to have a chance to ask questions if you want. And I want to talk, start, maybe I can start here. So it all starts with assessment for me. It all begins with doing the CDI range. So I know where the child is. If the child scores four on the range, they're really not ready for, for pictures of things with internal details. They're not ready for words. They're probably going to work on ventral, developing more ventral stream vision. And maybe we're going to launch some stuff around salient features. So the assessment is the place that I believe everyone has to begin. We're going to look at some things that have increasing amounts of complexity. But remember that the same child who only looked at objects that were phase one objects, you know, that it's so important to remember that that child who's in phase one could just be a child that ends up using some pretty advanced literacy or literacy of some type. They may become that child who can use a complex symbol system. If the child can discriminate these features, you know, it may be possible that the child can ultimately identify the salient features of symbols. How do you know these crazy looking things are letters of the alphabet? I bet you've never seen this exact display of letters before. But how do you know it? Because you know the salient features. And so that's what we're going for. I'm also going to skip ahead of these books of simple books. I've shown you guys this before, I bet. So we're always going to start with images of things that child knows. When we're starting to do move toward simple books or PowerPoint presentations that are like little computer generated books or things on the iPad with backlighting, we're going to always start with images, photographic images, because those are the easiest for the child with CVI to perceive, of things the child already knows. Not drawings of those things, not cut out pictures, not symbols from like a communication, you know, system, we're going to look, we're going to take exact photographic images. You can put them in the iPad, you can make them into simple books. And I will tell you that children, this last bullet I found to be really helpful, a lot of children with CVI most have to be taught directly that the object and the picture of the object go together. So this is your, this is a ball. This is your ball that you love. This is your spiky ball. This is a picture of that same spiky ball. You have to actually build in that teaching that a picture is a representation of something. So this is a picture I used this years ago, this little girl's first book, she knew past fires, she loved this duck. This is one of her favorite things, this O ball. And what it, what we did was begin with, there's, with cut out single color images or you can do this on an iPad, that's for sure. In different sizes, put one at a time in different positions and the, and the request was, where's your passport? Where's the picture of your passport? Here's your passport. Can you show me the picture of your passport? Okay, if she swatted, she doesn't have a lot of control over her arms at all. She needs a lot of help with this, but she, if she swatted at the bottom of the page, not so good. If she could get her hand where that pink part was, we had a pretty good idea. She knew that was the object. Here's her toy duck. I will talk about the ceiling features of duck. You know, the duck has a mouth called a bill. It's like a flat part and, and has these big feet that are all connected. The toes are connected called web feet that helps them swim. There's the O ball talking about the ceiling features. Now, if she can always, if she can always find single images, but when there's two images together, can't seem to isolate one of them, that probably means the complexity is too great. Okay, with three, same thing. So it's real. And this is a distractor. So this is a way for me to know if Erin touches either of the two ducks were good. If she goes to the red star, I know I haven't taught her ceiling features well enough yet. And I have to go back and reteach what her toy duck looks like. Should I start with a real duck picture? Not necessarily because she doesn't have experience with that. This is her toy duck. She has no more idea what duck is than flying to the moon, but she will know eventually. And it starts with me telling her how I know this is a duck. So we're going to highlight some of those features. If she can't find a duck, if she only goes to the yellow background on this one, then we know that, you know, color is still so important that we can't use it anywhere but on the failing features. Okay, adding a little more complexity. And then we build in some generalization skills. And so then we begin to begin go then finally after those realistic things to things that are more representative that are not, this is finally, and we're probably looking at a score of like seven or so on the CBI range to be able to use these kinds of materials. Okay, but then I want, and then we systematically add more background and we generalize, but I want to skip ahead now to words because we have almost, you know, very little time left. So how do you know then when you can start words? So look how much we skipped, huh? So how do we know when we can start words? When the salient features are identified by the child. So that child who can pick out a dog in any array of animal figures I give them, or they can show me the difference. I can say there's an elephant here but they never pick the rhinoceros. Those kinds of things tell us that child can zoom in on those details. When they can use visual information in groups of symbols or images, not tons, but a little more than, you know, two things together. When they become active seekers of visual information. So you start to see a little more visual curiosity when they have comparative thought. Okay, if they can discriminate these, and if they know that's a dog, even though that's a very odd picture, I would say then it's possible that the child can also discriminate the differences between a symbol for eat or drink, which are very similar letters like VDPQ or whole words. Now I am, so I've spent many years talking to communication people about why they use these kinds of symbols. Some things cannot be conveyed in a single picture, right? But, but I asked myself the question, are words really harder than these pictures, these images, these symbols? Okay, and words actually may not be more difficult. This is an abstract symbol. So is a word. See the question mark with the, with, you know, any of those three question marks or any of that clock that says time? I'm not sure TIME is more complex than the image that is used to represent it. So Sarah Blackstone and I have been working on this thing called vision language learning. And we are experimenting with, well, we also use some research by some people at Penn State University who showed, whose research shows that typically developing five-year-old children can't figure out what the pictures are that are often used in communication materials and systems with kids who are not typically developing. So we've been kind of looking at words. And words, we want to start with words. Once child has, you know, ventral stream vision, salient features and comparative thought. We then look at things that like we want to look at pairs of words and we want to outline those words. I'll show you really quickly. Color matters, you guys know that. Watch this video. We'll show you what, what the basic concept is of teaching a word, the child award using color, movement, and talking about salient features. The word act. It's a short word. It only has two letters. It starts with a random letter. And then it ends with two lines that cross. A is a random letter and it has a short stick on the right. The second letter is P and it has two lines that cross. There's a tall line and then there's a short line that crosses it. Okay. And so this is an example of using two really discrepant words to help the child see the shape of the word. We do an activity where the child actually places the word into the word shape to help reinforce that. That's not a brown, it looks brown, but it's yellow. So the child begins to visualize what that whole shape is, but the words, this is a top-down approach. This is not a bottom-up approach. We're going to teach a child not individual letters first. We're going to teach them whole words and some of the important letters that communicate the phonemic awareness that this word cup is spelled C-U-P ends in the word letter P and P says P. Look, it has a leg that goes down. It's one of those letters that has a round part and a tall part that goes below the line. Look at that. This is how it looks in the shape. Same thing with schedule. This one has three tall parts. Okay, we'd talk all about that. Let's see if you, here's the word. Christine, I've got a question of clarification here. I'll just read it out to you. It says, yes, the words and picks might be the same regarding complexity, but we can manipulate the picture so that the clock, for example, is one that the student is familiar with. This seems to me to still make pictures less complex than words. There is less we can do to manipulate the words. Thoughts? My thought is that it's a team decision. I think that that is fine. If you can use a realistic picture of something that makes sense to the child and is part of their environment and they understand that's great. All I'm saying is that people disregard the concept that words can even be used. This is the way that the children, the many, many, many children I've seen who now read, whether it's just like a list of familiar words, whether it's true, reading for pleasure, whether it's reading short passages, this is how they have learned. So I'm just offering this as an idea. You guys as a team, when in your teams need to do whatever seems to make more sense to you, but I've been shocked at how many kids can do this just as well or even easier more easily. So I'm sure I'm going to show you and this is a way to generalize that just like we did with the picture of the cat. Let's see if we can find all the words that meet the criteria that look like the shape of the word cup. This is again a story that was done for a boy. This was his first two words. First two words were baseball and run. He's asked, here's the word run. Show me what shape that goes in. Okay. Here's one shape and two words. Show me what word goes in that shape. I'm trying to help the child met a cognitive cognitively look at that word, but I'm also using high interest words that matter to him. And I will work on some of the words, letter sounds based on the spelling of that word. I'm going to offer him the spelling of that word and we'll talk about the letter sounds. I then will offer him a short sentence. We'll make a sentence together. We work through choice making and all kinds of things to come up with a sentence that matters to him. And all he has to do is pick the word from the top that has velcro on the back and put it in the shape there that ends their sentence. And then I'll read it again to see if it makes sense. We can then add more words and expand the length of the sentences to more paragraphs. And again, he's not reading all these words. He's reading three of them. But they're in the context of more words. And it gives him all, it gives him a lot of power. What's fascinating is that what's fascinating is there comes a time in which the color outlining fades away as the word is memorized as the word really is solid in the child's memory. And there comes a time at which the embedded skills of phonemic awareness, some letter recognition, classification of letters based on salient features and comparative thought. Let's find all the letters that have round parts. Let's find all the letters that have a straight line that goes down below. Let's find all the letters that have a hook at the bottom. There's a lot of work that goes into this. But what is really interesting is to see how many kids actually can put their toes in this water and do surprisingly well. And I'm not talking about just like kids like Griffin that you heard talking. I'm talking about kids who might not be able to really even use their voice, but can answer questions, comprehension questions that tell us they understood what they were reading. So literacy should be a team decision, should be related to function, but not necessarily restricted to picture symbols. And by the way, I want to reference Krysta Wilkinson at Penn State as the person whose research is used to look at symbol systems. So that's who I'm referencing there. Should embrace the wishes of the family and should increase access, independence and pleasure. So this is not the only way. This is a way I'm offering. This is a way that I have found very, very helpful for kids with CBI. And I hope that even if you don't think the child's going to use words, think about ventral stream vision, salient futures and comparative thought. And I love this picture that a parent made for their child at schools to try to remind people that no matter what they're trying to teach him, these characteristics really are critical to most of the things he does in the day. Okay. I think I'm past my time now. We just passed the 330 mark. So yeah, with that, thank you very much again, Christine. Any more questions? Are we good? Well, I'm not sure. There are no more questions in the chat. And I see no hands up. Okay. So I think we will end it there. And thank you everyone for taking part in and thank you, Christine. And we'll see you down the road. All right. Bye-bye. For number 3. Bye-bye.