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Introduction. Cerebral visual impairment (CVI) can present around birth or any time thereafter. Homonymous hemianopia is a common feature. The concept that functional improvement is unattainable augurs against active management. Dorsal stream dysfunction (or Bálint syndrome when severe) results from bilateral posterior parietal dysfunction but may go undetected, especially in children. Case Presentation. At 16 the patient suffered spontaneous left occipital lobe brain hemorrhage from a ruptured arteriovenous malformation. This was surgically excised. Short lived right upper limb intermittent jerking, with additional left sided weakness, ensued. Anomalous EEG recordings, with right-sided bias, arose from the posterior temporoparietal area. A right homonymous hemianopia was evident. During the ensuing 17 years she experienced multiple complex difficulties, until, at a lecture describing how to identify and support children with CVI, she realized she herself had many of the difficulties described. Visual assessment identified hemianopia and dorsal stream dysfunction. Discussion. Following identification, characterization, and explanation of the impact of her visual difficulties, she both gained greater awareness of her visual difficulties and their impact and developed a range of strategies leading to functional improvement of her visual field loss and amelioration of her dorsal stream dysfunction, with great improvement in quality of life.

Introduction Cerebral visual impairment (CVI) typically affects children's overall functioning in visually cluttered environments. This study aims to consider whether the removal of classroom clutter ameliorates visual problems and the associated behavioral difficulties for these children. Methods Two classrooms at a special school were de-cluttered. Changes included: covering glass panels with thick black paper; hanging sheets over open shelving; creating areas of blank wall in front of the student to focus attention on work; removing unnecessary equipment and furniture; and taking down information on windows and walls, and that hanging from ceilings. Teachers, paraeducators, and students worked in these classrooms for two weeks, following typical daily routines. Observations by teachers and paraeducators of students’ behavior and learning experiences before and after de-cluttering were sought through interviews. Findings The perspectives of the teachers and paraeducators were that de-cluttering had a positive effect on the students’ learning experiences and behavior and also on their own functioning. They also considered the fact that creation of learning spaces lined with black paper resulted in greater attention and focus, but that students continued to be distracted by the noise and movement of others. Discussion The potential link between cluttered classrooms and students’ functioning and behavior indicates that visual clutter may amplify the visual difficulties associated with CVI and distract the students from learning activities, and is in line with current literature. Changes to classroom layouts that include specific areas for different learning activities, including “black hubs,” may therefore benefit students with CVI. Implications for practitioners This pilot study suggests that the elimination of classroom clutter and the creation of black hub learning spaces enhances functioning and merits further investigation. A study that compares specific behaviors and performances, before and after implementation of de-cluttering strategies, might also determine whether the positive effects described by the teachers can be further corroborated.

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The Austin Playing Card Assessment was developed to help identify visual perceptual difficulties related to clutter and to determine the nature of each child’s difficulties. The aim of this pilot study was to find out whether a task of progressively increasing difficulty, for pairing playing cards, is effective in identifying these kinds of visual difficulties. Parents of 11 research and 11 control subjects completed an inventory to ascertain whether their child’s visual behaviours were suggestive of visual perceptual difficulties. All participants completed the Austin Playing Card Assessment in two separate locations, with an ABA experimental design. The time taken to complete each level of the test was recorded. Structured observations were made of the participants’ visual behaviours when completing the assessment. Inventory scores from the research subjects indicated a higher likelihood of visual perceptual difficulties, whereas the control subjects’ scores did not. Research subjects were also slower at completing the Austin Playing Card Assessment. Independent T-tests comparing the time taken across all levels of difficulty ranged between p = .011 to p < .001. Cohen’s d calculations demonstrated a large effect size. Overall, research subjects demonstrated more indicators of visual perceptual difficulties. The Austin Playing Card Assessment has the potential to be effective for detecting and identifying visual perceptual difficulties in children. Information gathered through the assessment process could also be used to inform intervention. As this was a pilot study, further research is needed to support these findings.