# For speech, occupational and physical therapists > Start with the space, then the student. Use a plain background, a quiet room, light beside or behind the student, and one item at a time where they see best. Present, then wait in silence. Expect many students to look, look away, then reach. Build communication systems with fewer, spaced symbols in fixed places, and follow the vision teacher's assessment wherever there is one. Updated 2026-10-04. Canonical: https://cviexplained.com/for-therapists/ Many school therapists meet their first student with CVI with no training in it. These are starting points, not protocols. Where there's a vision teacher (TVI), their assessment comes first. ## Set up the space - **Plain background.** Face the student away from posters, or stand a black tri-fold board behind your materials. - **Quiet.** One sense at a time is easier. Turn off music and close the door. - **Light.** The student faces away from the window. Use a lamp or task light, and dim it if they tire. - **Still.** Sit where nobody walks behind you. - **Same setup every session.** Familiar is easier to see. ## Present one thing at a time - One item on a plain background. Familiar things first, real objects before pictures. - **Present, wait, then talk.** Put the item down, stay quiet while they look, then name it. - If the student doesn't notice a still object, move it slowly and silently, a little to one side, then stop and wait. - Many students can't use your face or a mirror for speech models. Use touch cues and sound instead. ## Positioning and where they see - Ask the TVI where the student sees best. Many need things at eye level and miss what's low on the table or floor. A slant board or plain dark box lifts items. - Give full physical support first. When a student works on balance or posture, expect them to have less vision to spare, and use more touch, sound and words. ## Reaching - Many students look, look away, then reach, sometimes from the side or past the item. That's a strategy. Don't block it, and don't prompt "Look at it." - Keep items in the same place, so memory and touch can help. - Make the target stand out: bright tape around a container rim, a lit screen, a task light. - For balls and anything fast, add sound or touch cues. ## Communication devices and symbols Build around the student's strongest sense (vision, touch or hearing), from the TVI's learning media assessment. - **Fewer symbols, spaced out.** When teaching new words, cover the ones you aren't using. Some students need one symbol at a time, shown and spoken by you. - **Same place, every time.** Fixed positions let the student build a motor plan and predict where things are. - **Plain backgrounds.** A black or neutral board, bright single-color symbols, and few colored borders. - **Real before abstract.** Real objects and photos of the student's own things often work before standard symbol sets. - **A backup for loud places.** A simple switch or a small set of symbols for the cafeteria and hallway. - **Eye gaze** asks a lot of vision. Plan it with the TVI: where the screen sits, how many targets, and how long a look takes to count. ## When there's no TVI, or they come once a month - Ask the family what works at home. - Ask for the functional vision assessment (a TVI's check of how the student uses vision day to day) and read the recommendations. If there isn't one, raise it with the team. Families can ask for an evaluation in writing. See [IEP basics](/iep-basics/). - Note what the student responded to, where, when, and in what light. With permission, take short videos for the TVI. - Your job isn't to train vision. It's to make your sessions accessible. ## Working with the TVI - Ask three questions: Where does the student see best? How many things at once? What colors and light help? - Invite them to a session, sit in on theirs, and co-treat when you can. Share photos and videos in one folder. More from Perkins: their [CVI Educator Toolbox](https://www.perkins.org/resource/cvi-educator-toolbox-resources-across-the-disciplines/) has a one-page overview for each discipline. ## Questions people ask ### Do all students with CVI need high-contrast symbols? No. Every student is different. Some need real objects, some photos, some can use simple symbols. The vision teacher's assessments show which, so build the system with them. ### The student uses their device fine in my room but not in the cafeteria. Why? Noise, clutter and tiredness all reduce what a student with CVI can see. Perkins suggests a simpler backup system for loud places, like a single switch for "I need a break." ## Sources - [Perkins School for the Blind, CVI for Speech-Language Pathologists](https://www.perkins.org/resource/cvi-for-speech-language-pathologists-slps/) - [Perkins School for the Blind, CVI for Occupational Therapists](https://www.perkins.org/resource/cvi-for-occupational-therapists-ots/) - [Perkins School for the Blind, CVI for Physical Therapists](https://www.perkins.org/resource/cvi-for-physical-therapists-pts/) - [Perkins School for the Blind, 5 essential steps to finding the best AAC system for a learner with CVI](https://www.perkins.org/5-essential-steps-to-finding-the-best-aac-system-for-a-learner-with-cvi/) - [Perkins School for the Blind, CVI and visual guidance of the upper limbs](https://www.perkins.org/cvi-visual-guidance-of-upper-limbs/) - [Perkins School for the Blind, CVI and the impact of motion](https://www.perkins.org/cvi-impact-of-motion/) - [Perkins School for the Blind, CVI Educator Toolbox](https://www.perkins.org/resource/cvi-educator-toolbox-resources-across-the-disciplines/) --- CVI Explained gives general information. It is not medical or legal advice and it does not diagnose.