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In this article, we present findings from a study that examined shifts in special education pre- service teachers’ knowledge and applied instructional practices about visual representations (VRs) in mathematics for students with disabilities (SWDs). Using a case study approach, data was collected from 25 pre- service special education teachers before and after instruction. The data revealed increases in both knowledge about (definitions, roles, how to use VRs in instruction, type of instruction) and application of VRs for SWDs. Despite the positive shifts, challenges within the mathematics content remained. Implications for pre-service teacher preparation and research are provided.