Visual spatial learning disabilities and braille instruction

Participants

All participant names have been changed to preserve privacy. Maddox, a sixth-grade braille reader recently diagnosed with a visual spatial learning disability, his mother, as well as Michelle, Lynn, and Ana, three teachers of students with visual impairments (TVIs) who had worked with Maddox, participated in this study. Cognitive testing placed Maddox in the average range, though he was independently reading at the first-grade level. He had received braille instruction since kindergarten utilizing the Mangold Basic Braille Program as well as the Building on Patterns curriculum. As it became more obvious that he was not reading on grade level, his special education teachers tried intensive phonological interventions, the Orton–Gillingham Reading Program, nonsense word recognition, repeated readings, and the PCI Reading Program all with minimal success.

Maddox demonstrated strong tactile discrimination skills, as well as the ability to state verbally which dot numbers made up each letter. However, he was unable to distinguish whether dots were in the left/right or top/middle/bottom of the cell when reading or producing braille. When given basic tests of phonemic awareness, he displayed strong understanding of rhyming, sound and word discrimination, syllable splitting, blending, phoneme manipulation, phonemic segmentation, and phoneme deletion. Listening to auditory books was his favorite leisure activity, yet when asked to read himself he would cry, flee the room, or begin to bargain for a different task. Participants were interviewed to gain their perspective on the effectiveness of the intervention.

Settings

Reading instruction took place one-on-one in a classroom space with few distractions from August 2019 until March 2020, when the COVID-19 pandemic required instruction to become remote. During remote learning, a camera was placed so the researcher could see his fingers as they moved across the braille or on the brailler keys, and materials were delivered to his home interlined in dark black so that the researcher was always aware of what cell his fingers were on. Due to COVID-19 school protocols, interviews with all participants took place through Zoom, an online audio and video meeting platform.

Procedure

The Institutional Review Board at the University granted ethical approval for the study. To begin, Maddox worked on thinking about braille in an entirely new way. The researcher asked Maddox to place a ball in a box, as the ball rolls around it would either become caught in the corners or fall into the middle. Thinking of the corners of a box led to the position of the braille letters D, F, H, and J, which, when brailled correctly, can form a box. As their dot positions are so similar, they are frequent reversals for braille readers. Maddox was asked to think of the braille cell as the corner of a box, either his finger would push against the edge of the box or fall out of the box just like the ball. The letter D was presented first and he determined that it was more obvious to him where he would push against the box. Working with a row of just the letter D, Maddox would push his finger up and to the right starting with it on the letter and moving it off, as the researcher asked: “Which way does it push?” The researcher would then say “D.” It then moved to the researcher asking, and him moving and telling the letter name. When he became proficient with the letter D, the researcher added its reversal, F. Again, F started in isolation and followed the same procedure with him moving his finger up and to the left this time. After Maddox had mastered both letters, the researcher combined them in a mixed line. With each new line the researcher would ask, he would push, and the researcher would label and he would push and label when ready. The same procedure continued for all his reversals except for E and I. For those, instead of pushing, he would “slide” down the letter and the cue would be which way does it slide.

The focus was only on uncontracted braille to decrease the number of possible reversals. Once he became 95%–100% accurate with letters in isolation, they were put into simple consonant vowel consonant (CVC) words, moving to words that were more complex. The researcher continued to give him the cue of which way does it push if he became stuck. Although the researcher was asking for a direction, he never answered in words, instead his answer was the movement of his finger adding a proprioceptive component. The pattern followed the order of letter, simple CVC, more complex words, and then sentences to build his confidence and ensure mastery of letter recognition before moving to more complex words.

Interviews were conducted with Maddox, his mother, and a group of three TVIs who had worked with him in the past following a year of braille instruction utilizing this multi-sensory method. Interviews took place over a video conferencing platform due to restrictions put in place for COVID 19. Questions centered on Maddox’s experiences with braille and braille instruction both academically and social emotionally focusing on the differences or similarities between the older systems and the multi-sensory approach.

Data collection methods

Throughout the 2019–2020 school year, data were collected on Maddox’s number of correct letter responses, his progress on reading the first 100 Fry sight words, and simple sentence reading. The researcher recorded observations by tallying: refusals, number of times he left the area, and frustration level during reading activities as demonstrated by the number of angry outbursts he had. The researcher compared these data to his past performance in the same areas. Past performance was gained from past Individualized Education Programs (IEPs), notes taken by other TVIs or learning specialists, and past testing results.

At the end of the school year, interviews took place with the participants using semi-structured open-ended questions focused on participants’ perceptions of the student’s outcomes both academically and social emotionally with both the previous methods, and the new multi-sensory method of braille instruction. All interviews were audio recorded with participant consent and transcribed. Transcribed interviews were returned to the participants to determine whether the interview was a true representation of their thoughts. After coding the transcripts, an independent third party involved in visually impaired education reviewed the coding to ensure agreement.

Data analysis

After each interview and each observation, the researcher recorded their initial impressions. They then went through each transcript line by line highlighting any pieces that represented the academic or social emotional impact of braille instruction on the student participant. Each experience was summarized in a word or two that best captured the essence of the experience. The researcher then looked for similarities in individual codes across interviews, observations, and data to develop themes. Data gained from the school year was compared with the data available from the triannual review completed the prior year and combined with the interview answers to gain the study results.

Letter/word identification

All participants indicated that prior to beginning the multi-sensory reading strategy Maddox demonstrated significant reversals creating difficulty with recognizing letters and reading words. On his fifth-grade IEP, his learning specialist placed him at inconsistently knowing 17–20 out of 26 letters and only 48% accuracy with sight words. Michelle noted “he really couldn’t spatially [determine] the dots, he could not distinguish where they were in relation to each other to be able to really identify braille symbols efficiently.” Other participating TVIs working with Maddox, as well as his mother, echoed this. At times, he would take up to an hour to read a single sentence, as he became so caught up in decoding individual letters. By the end of his sixth grade year, he was able to read 4–5 questions in half an hour along with dictating the answers to those questions.

Maddox improved to 26 out of 26 letters 90% of the time and 60% accuracy with sight words following a year of the multi-sensory intervention. All three TVIs interviewed indicated he demonstrated decreased reversals and increased decoding skills. Maddox stated, “Some of the confusers [reversals] I had are easier to deal with now.” Michelle noted that after intervention “he read fluently, even if he was a little bit slow, it was fluent and you could understand; he read exactly what I brailled to him.”

Spatial orientation

Part of the multi-sensory approach included removing references to the position of the dots (left/right, top/middle/bottom) and instead focusing on the overall feel of the dots and his impression of the direction in which the cell itself moved. Eliminating positional words that had been an obstacle for Maddox for so long allowed reading to become more instinctual. He shared that “it’s a lot easier with the pushing thing, when you’ve got them in big words, it still takes a while for you to figure it out” but overall the difficulty decreased. His improvement in spatial orientation transferred over to other areas as well. Lynn shared that it “even impacted into his iPad usage knowing and understanding those concept.” His Certified Orientation and Mobility Specialist utilized some of the same directionality strategies and terminology from braille lessons during mobility lessons. He was able to demonstrate increased directionality while traveling routes, by the end of the year traveled between classes without assistance, and for the first time was able to read the signs throughout the building.

Independence

Prior to the intervention, Maddox’s struggle with the spatial nature of braille cells led to dependence. Lynn shared that “he pretty much had to have an adult with him all the time to support his skills or else he wouldn’t have been able to access the curriculum.” At the same time, he had a high level of internal motivation to participate with his friends and compete on the same level with them academically. Ana expressed that his learning disability

was really impacting him because he couldn’t be independent. So that emotionally was really hard because he didn’t want his friends to see him cry, he didn’t want to break down, but . . . he was so frustrated, he just didn’t know what else to do a lot of times.

Completing any kind of work at home had been impossible as he melted down and refused to participate.

After the intervention Ana noted that Maddox “was just a different kid . . . [he had] typical [middle school] mumble grumble, not a complete meltdown because he was so confused.” His mother noted that homework time was much more pleasant. “Now we are able to get through the whole thing because we can come with a calm attitude and the confidence he has that he can finish it.” Throughout elementary school and for the beginning of sixth grade, Maddox had either a one-on-one paraprofessional or other adult with him at all times. By the end of sixth grade, Maddox no longer had a paraprofessional with him throughout the day and only required support from the TVI for a couple of hours a day. He functioned with minimal support from the classroom teachers the remainder of the day.

Self-concept

Maddox’s mother shared that he had gotten to a place where “his self-talk is just not nice: ‘I can’t do it,’ ‘I’m stupid,’ or ‘I’m never going to learn it!’” He was very self-aware that his braille reading skills were not where they should have been and that he was unable to participate at the same level as his peers. Michelle expressed that “he really had anxiety around performing in class if he didn’t have assistance . . . overall he had very low confidence in his ability to read and write, even though verbally he can tell the most amazing stories.” The impact from one bad experience at the beginning of the day would throw him off for the rest of the day.

After intervention, Maddox’s mother reported that

he is a lot more confident . . . knowing that he can do it and that he is very smart and that he has the tools he needs to be able to do it. . . . Once he got more confident in his ability to do just that piece of it, I think he got a little bit more confident in his ability to do a lot of other things in general [he is] proud of himself about some of the work that he has done.

The TVIs interviewed echoed his mother’s sentiment. Lynn felt he had

an overall grasp of having more control in his own life. . .when you think about a child who has blindness . . . a lot of things are out of their control, so I think that is a confidence booster for him as well.

While Ana shared that “if we can take away the frustration. . . I saw what a change it made in his excitement to learn when he had something that made sense to him.”

Discussion

Utilizing a multi-sensory approach eliminating all references to directionality concepts positively impacted Maddox’s ability to decode braille letters, especially those that are mirror images of each other. He improved from inconsistently reading 17–20 letters to consistently reading all 26 90% of the time and his accuracy on sight words improved from 48% to 60%. The resulting increase in fluency allowed him to more successfully read and interact with sentences as well.

The positive impacts were not limited to reading ability. As Maddox’s reading skills improved, participants noted that he demonstrated greater overall positive self-concept and confidence. He was more willing to participate in school activities without constant adult supervision and decreased the need for a paraprofessional throughout his day. For the first time at school, he was able to develop a sense of pride in what he had accomplished and began to increase his self-advocacy.

This study underlies the need for TVIs to rethink traditional instructional practices when approaching braille instruction for learners who are struggling. By nature, braille is a highly spatial media; therefore, the need to lessen or eliminate the impact of spatial concepts becomes very real for students with NVLDs. While the strategy used within this study was developed specifically for a student with a NVLD, the same concept could assist other beginning braille readers as they navigate through the many reversals present.

Limitations

This study was conducted using a single student and followed him for a single school year. Future research should be conducted looking at multiple students across a longer time frame to increase generalizability.