Journal of Visual Impairment & Blindness

Introduction: Cortical or cerebral visual impairment (CVI) is the leading cause of bilateral visual impairment in developed countries. The goals of this study were to explore the CVI education and training received by occupational therapy practitioners and teachers of students with visual impairments and to quantify the confidence of these professionals to evaluate and work with children who are diagnosed with CVI. Methods: An Internet-based survey was conducted with a volunteer sample that included occupational therapists, certified occupational therapy assistants, and certified teachers of students with visual impairments who practice in 50 U.S. states; Washington, D.C.; and Canada. The survey was posted on professional organizations and social media websites, as well as emailed to colleagues at organizations such as the Association for the Education and Rehabilitation of the Blind and Visually Impaired, schools for students who are blind, and local universities. Data collection occurred between June 2019 and November 2019. Results: Surveys were completed by 205 respondents from 43 U.S. states; Washington, D.C.; and Canada. Occupational therapy practitioners consistently reported lower rates of formal education in CVI, with only 25% of occupational therapists and 47% of certified occupational therapy assistants receiving education on CVI in their academic programs. Less than 23% of occupational therapists received training on CVI assessments, whereas 75% of teachers of students with visual impairments had training in CVI assessments. Additionally, respondents indicated reduced satisfaction with their knowledge and skills for treating or teaching children with CVI. Discussion: The results indicate a gap in formal CVI education for occupational therapy practitioners and, to a lesser extent, teachers of students with visual impairments. Due to the increasingly high prevalence of CVI, the gap in formal education on CVI is significant. Implications for Practitioners: Results indicate the need to increase formal and continuing education for occupational therapy practitioners and teachers of students with visual impairments.

Introduction: American media-accessibility pioneers in the 1970s and 1980s not only sparked interest in the academic study of audio description, they also originated many practical techniques, protocols, theoretical perspectives, guidelines, and standards that persist in the fabric of this type of work decades later. In this study, we located and analyzed source documents for two oft-mentioned innovators—Gregory Frazier and Margaret Pfanstiehl—to shine light on their individual perspectives through a historiography of their foundational writings and associated media. Method: This analysis was conducted on publicly available source documents, such as Frazier’s landmark thesis and also included a trove of Pfanstiehl’s personal correspondence, as a way to establish particular points of theoretical and historical interest. Results: We found that despite the prominent place of Frazier and Pfanstiehl in audio description lore, neither actually published much writing about what they did and why they did it. Some of what they wrote has been selectively repeated, but other parts have been forgotten. In that respect, this research method could be used to more precisely trace and identify where particular practices emerged, under which theoretical perspectives, and complications. It also can help to show how these ideas were documented and tested during their emergence and domestication, as a way to gauge procedural rigor as well as validity of related findings. Discussion: Audio description scholarship needs theoretical anchors, but it also needs systematic testing of assumptions inherent in those theoretics, which this study helps to identify. Implications for Practitioners: Audio describers invariably will encounter the moment when an assertion of “this is the way we do it” collides with the curiosity of “why?” To promote best practices, the field has to understand where practices came from, how they developed, and as Frazier recommended, put those ideas to “objective” tests.

Introduction: “High-tech” assistive technology (AT) plays a critical role in the lives and educational experiences of students with visual impairments (i.e. those who are blind or have low vision). However, little is known about how these students actually use AT within their educational programs. Methods: A survey examining AT use and services among 51 students with visual impairments addressed their personal characteristics, device characteristics, device usage, AT assessment, and AT instruction. In addition, 12 teachers provided perspectives on their district's AT services and policies. Results: Students primarily used commercially available AT to access print. Some variations in use were found between elementary and secondary students. Instruction of devices was highly aligned with students’ device use. Discussion: High-tech AT can meet diverse needs among students with visual impairments. Individualization of AT selection and services remains essential. Implications for Practitioners: Educators should consider AT for a broad range of student needs, promote device use at home, reflect on their instruction, and pursue professional development in this area.

Introduction: The objective of the current study was to design and pilot-test a nonverbal intelligence test for children and adolescents with visual impairment (i.e., blindness and low vision) aged 10 to 16 years. Method: A three-dimensional haptic matrix test of nonverbal cognitive abilities (3-DHMT-CA), initially developed for adults with visual impairment, was adapted and administered to 25 juveniles with severe low vision or blindness and 25 sighted peers. The test consisted of 22 tactual matrices with a missing element, and juveniles were asked to understand the logical scheme underlying each matrix and to complete it. Convergent validity was assessed in the sighted group with the Standard Progressive Matrices. Divergent validity was measured with the Verbal Comprehension Index (VCI) and the Working Memory Index (WMI) of the Italian version of the Wechsler Intelligence Scale for Children–Fourth Edition. Between-group differences were analyzed with Student’s t-test and ANOVA. Results: Results show a high correlation with the convergent measure (with the Standard Progressive Matrices), and the moderate correlations with divergent measures (VCI and WMI). Between-group differences showed significantly higher scores for sighted peers than juveniles with visual impairment at 3-DHMT-CA, and non-significant differences at VCI and WMI. Discussion: This haptic nonverbal cognitive test showed good psychometric properties, but it needs to be validated in a larger sample with a qualitative analysis of solution strategies because juveniles with visual impairment seem to use different verbal and working memory strategies. Implications for Practitioners: The 3-DHMT-CA and the haptic two-hands modality seem to be suitable to test nonverbal cognitive abilities in juveniles with visual impairment. Practitioners should focus on empowering verbal and working memory abilities, since they may affect nonverbal cognitive abilities as well.

Introduction: This work investigates if simple two-dimensional (2D) tactile shapes can facilitate encoding, retention, and retrieval of associated information in the form of one-word labels. It also questions the need for the resemblance of tactile graphics with respective visual referents. Methods: Four experiments were conducted using recall tasks with verbal and tactual triggers. Students who are blind from schools for blind students in Indianapolis, Indiana (USA) and New Delhi (India) participated in these experiments. Participants learned 12 shapes with assigned (two sets of) one-word labels categorized as consonant, dissonant, or abstract. Recall tasks were conducted after 1 week and after 4 months using verbal and tactual triggers. Results: The results of experiment 1 show that recall performance for consonant associations was higher than that for dissonant and abstract. Experiment 2 shows the recall performance using orally narrated verbal triggers, while experiments 3 and 4 use tactile triggers (both verbal and shape). Additionally, in experiment 4, the participants were observed recalling most associations after 4 months. Tactile verbal triggers (braille) invoked better recall accuracy as compared to tactile shape triggers. Discussion: The results and discussion with schema theory suggest that resemblance to visual referent (or similarity of tactile shape with real-life visual stimuli) is not necessary for learning associated labels. Additionally, simple 2D tactile shapes can support long-term retention of associated verbal information. The presence of primacy effect (better retention of first few associations) and distinctiveness effect (better retention of unique associations). Implications for Practitioners: The inferences of this work can influence the redesign of educational material and pedagogy for students with blindness by: (1) contributing to the development of a standardized set of symbols with associated meanings and using them for book annotation or indicating the genre of a graphic; (2) using simple tactile images instead of complex “visually correct” images.

Introduction: Three-dimensional (3D) printing can be used to produce tactile teaching materials for individuals with visual impairments. Although 3D and 2.5D teaching materials are based on realistic content, no systematic conversion model for 2D materials exists. Here, we combined the previous findings and this study's results and technology to develop procedure recommendations for tactile-graphic design. Methods: We enrolled 19 participants with congenital blindness to identify and name the tactile graphics. The tactile graphic design involved height differences, materials, and operation zone areas. We recorded the identification time, accuracy, and National Aeronautics and Space Administration–Task Load Index assessment performance and conducted a three-way analysis of the variance to investigate the interactions. Results: A larger area resulted in a better performance in seconds; model 3 (high lines and low planes) under large areas obtained the lowest speed and accuracy performances. Large areas were associated with a better intelligent load, physical load, mental load, and self-performance scores. Model 1 (equal line and plane heights) yielded better physical-load performance. Model 3 was found to be superior when thermoplastic elastomers were used under large areas. Discussion: Larger area ratios could increase the identification performance. As model 3 is not recommended, model 1 was found to be better than model 4 (non-operation-guiding zones become planes) in terms of physical load. Model 2 (low lines and high planes) required more time than model 1; hence model 1 is recommended. Fused deposition modeling (FDM) materials such as FDM_TPE (thermoplastic elastomer) increases the identification steps and should not be used first. The FDM_PLA (polylactic acid) platform is inexpensive and easier to operate than stereolithography (SLA) materials such as SLA_ABS (acrylonitrile butadiene styrene); hence FDM_PLA is recommended. Implications for Practitioners: When designing the graphics, a plan view photograph of the object can be obtained for delineating the contours first. Adjustments should be made after confirming the presentation model. The graphic may then be transferred for 3D printing with PLA materials.

Introduction: Comparison of sway parameters of visually impaired participants to that of the sighted population may give insight into the intrinsic risk of falls relative to the surface. Sway is a natural mechanism to adjust the posture and maintain balance. But the sway characteristics on uneven surfaces are ill explored. There is a paucity of evidence on baseline values of sway amplitude in visually impaired women in comparison to sighted women, which underpins the importance of this study. Methods: Eighteen visually impaired young women and an equal number of age-matched sighted peers were recruited by convenience to this prospective observational study. Sway amplitude of the participants were measured using a sway meter on three different surfaces, with eyes opened and closed conditions, using videography and analyzed using Kinovea motion analyzing software. Demographics and participant characteristics were summarized using descriptive statistics. The comparison were performed using independent sample t-test. Results: Visually impaired women demonstrated lower amplitude of sway than sighted young women, irrespective of the surface. Discussion: There was a gradual increase in sway amplitude as the standing surfaces changed from even to sand and pebbles, respectively, for both groups. Implications for Practitioners: Contrary to the existing evidence, the results of this study indicate that visually impaired young individuals may not be not at higher intrinsic risk of falls on various terrains than their sighted peers. The authors hypothesize that the lower sway among visually impaired participants can be attributed to the learned strategy for safety from exposure to real-life pragmatic environments during everyday activities, which enabled them to adopt postural strategies as a safety measure. Hence, this strategy can potentially be used in dynamic situations to decrease the propensity for falls during ambulation in visually impaired individuals.

Walking alone (without assistance) is considered by the World Health Organization as the terminal independent walking milestone, typically achieved by 18 months. Children born with severe visual impairment and blindness (visual impairments) do not achieve independent walking milestones on time. This study examined independent walking in 35 children with visual impairments (VIs) aged 14–69 months. Before treatment, they had limited to no anticipatory control. Wearing the pediatric belt cane (PBC) provided them with consistent, tactile anticipatory control. Thirty-five participants with VIs’ independent walking milestones were analyzed using pre- and post-video recordings provided weekly 1 month before and the 3 months after obtaining the PBC. The PBC consisted of a rectangular frame that connects to a custom-made belt with magnets. The PBC provided no weight support. While none of the participants had motor impairments, 80% of them were receiving physical therapy services prior to obtaining a PBC. Fifty-four percent were receiving orientation and mobility services, and half were equipped with hand-held mobility tools (long canes, adaptive mobility devices, push toys, and reverse walkers). A paired samples t-test indicated a significant difference between the before and with PBC scores (N = 35, t = −13.0, df = 34, p = .000). Participants demonstrated significantly improved independent walking after wearing their PBC regularly over 3 months. Before PBC, the participants demonstrated delayed independent walking milestones. Most participants walked only with assistance. Those who walked independently experienced unavoidable bodily collisions and used a slow pace with poor gait patterns. After being provided PBCs, these same participants’ independent walking milestones improved, all but three were walking independently and five were observed independently running. Wearing their PBCs allowed them to perform motor skills, like running, often described as needing to be specifically taught to learners with VIs due to their inability to learn incidentally through visual observation.

Introduction: Interveners are paraeducators who have been trained in deafblind strategies. This study evaluated the effectiveness of an online training project for intervener candidates. Methods: The training project utilized the Open Hands, Open Access (OHOA) Intervener Training Modules in conjunction with synchronous meetings and coaching. Results: Upon completion of the program, a survey was conducted to evaluate the participant's preparation to perform their job as an intervener, the most helpful parts of the program, suggestions for improvement, and overall satisfaction with the training. Additionally, participant attrition (17%) and pursual of intervener certification were examined. Discussion: The results of this study indicated that this type of program can successfully impart the knowledge and skills one needs to improve their skills as an intervener, reduce attrition of participants, and individuals can subsequently complete a rigorous certification process based on national standards. Implications for Practitioners: State deaf-blind projects as well as other entities engaged in professional development can use the materials from this project to train staff in deafblind strategies. The flexibility built into this training can be enticing for educators and paraeducators seeking professional development.