by Jeff Altman
From the Editor: Jeff Altman is a blind mobility instructor who works for Nebraska Services for the Blind and Visually Impaired (NSBVI). Here he discusses the use of sleepshades and structured discovery and the fact that both are sometimes seen as incompatible with the use of remaining vision--a contention he flatly rejects. We reprint the article from the winter issue of the Nebraska Center for the Blind Newsletter. Here is what he has to say about learning new techniques, building a skill set that doesn't rely on vision, and then using remaining vision effectively to lead a safer and more satisfying life:
While there are many good reasons for using sleepshades during center training, some situations can create confusion for students. It is not unusual for people to wonder why sleepshades are used at all; in fact, many people have strongly opposed their use, and for these reasons several articles have already been written to address these concerns. The Nebraska Center for the Blind is firmly committed to the use of sleepshades as a teaching tool because years of experience have shown that this approach to training leads to a higher level of independence and success. Therefore the center requires students to wear the sleepshades eight hours a day, five days a week.
Given this policy, why aren’t students asked to wear sleepshades throughout their waking hours? There are two related answers to this question. First, it simply wouldn't be comfortable for students to wear sleepshades for extended periods, and we recognize that many people have a physical need for a break from the shades. Second, center students need to have the opportunity to learn to incorporate the use of their developing nonvisual skills with their usable vision. Each student needs to come to understand those situations in which his or her vision works well and those in which the better choice would be to use the new, nonvisual alternatives. This understanding must occur in each student, and this integration is just as important as developing a complete set of nonvisual techniques.
These two answers lead to a host of other questions that are important for students to ask and have answered. Some frequently heard include why are students with a high degree of usable vision required to use their canes when they are not wearing the sleepshades? Why are students with relatively high levels of vision discouraged from using their vision to work with the computer at the apartments? Why should a student who does not have enough vision to read print have to go to the trouble of arranging for a sighted reader when other center students at the apartments with enough vision to read and inclination to help are available? Why should a student with some useful vision not use his or her vision to assist a totally blind student or a staff person to find a dropped object, locate a chair, announce when a traffic light has changed to green, or help set an alarm clock? Does this mean that center staff believe that blind people with some vision shouldn't use it at all?
As confusing as the center's policies may at first appear, we have good reasons for each of them. While the overall goal of any rehabilitation training program is to prepare students to obtain appropriate employment, one of the most important purposes of center training is to assist agency clients to become experts in their own blindness. This means being able to make informed choices regarding techniques they will use in their everyday lives as well as in the workplace. In some situations a visually based alternative may be more efficient, while others may be better accomplished using a nonvisual method. An individual cannot make an appropriate choice of techniques unless that person becomes well practiced with the methods that would otherwise be unfamiliar. Since the majority of people rely on their vision for the tasks of everyday life and in the workplace, most often the less familiar techniques tend to be nonvisual. Only after an individual has truly mastered the less familiar nonvisual techniques can he or she make a balanced comparison with the more familiar and socially acceptable visual methods.
During center training students are expected to use their canes at all times, except when they are in their own apartments. The reasons for this policy are really very simple and important. First of all, students with limited vision need to learn which method of gathering information is most effective in their own situations: the cane and its related nonvisual techniques or their limited eyesight. They must also learn to use both sources of information in concert. This means learning through experience, making mistakes, and experimenting to find the best combination of skills. Cane travel requires practice, and center classes simply don't provide enough time to develop proficiency. In addition, each person must come to terms with the social issues that using a cane can create. The general public often reacts to a person with a white cane in socially awkward ways ranging from excessively helpful to outright strange. When it becomes apparent that the blind person has some useful vision, the interaction can be even more uncomfortable, causing the blind person to feel self-conscious, even if most people do not react at all. Using the cane in nearly all situations provides center students with the experience to make good judgments about which skills best meet their needs, to learn to blend visual and nonvisual skills effectively, to refine their cane techniques, and to develop positive responses to even the most awkward social situations related to blindness.
Student experiences in the apartments are as much a part of training as are classes during the week. Developing new skills, such as operating a computer using synthesized speech and keyboard commands, requires far more practice than can be provided in daytime classes. For this reason a computer is available for student use in the apartments, and often instructors give homework assignments. Students who employ their vision to work with the computer, even if they use a screen-enlargement program, are not practicing nonvisual techniques; some will compare their well-developed, visually based computer skills with their limited experience in the use of keyboard commands and listening skills. It is all too easy for them to become convinced that using a computer visually is a superior method, even though in reality many nonvisual computer techniques are much more efficient. It is also not uncommon for a student with some useful vision to attempt to assist a student who is unable to read the computer screen visually. The problem with this seemingly kind gesture is that neither student learns the nonvisual techniques to accomplish the task.
Learning to obtain and work with a reader is one of the most important skills that a blind person can develop. When other center students jump in to help with reading, they are denying the student who needs print-reading assistance the opportunity to learn many aspects of this skill. Even more troubling is that this intended act of kindness can reinforce in the minds of both students the notion that the more vision a person has, the better off he or she is. This false notion can obscure the fact that a well-educated, highly skilled, motivated blind person is much more likely to be successful than a less motivated person with eyesight who has not had the opportunity for education or to develop critically important skills. Therefore, it is not vision that determines the outcome, but the experience and characteristics that are a part of that person's makeup.
Each of the skills taught in center training, including finding a dropped object, locating a chair, knowing when a traffic signal has changed, and correctly setting an alarm clock, is the kind of daily task that underpins independence. Every center student needs to find the best alternatives to accomplish these if he or she is going to live in the world and be a contributing member of society. Nonetheless, something much deeper is at work here--the need to believe in the ability of all blind people. When an individual with vision performs a task for someone with less vision, it takes away the sense that functioning as a blind person is not only possible but of equal merit. When a student with some vision steps in to assist a blind staff member, it takes away the opportunity for that staff person to model the nonvisual techniques and attitudes necessary to be successful as a blind person.
The emphasis on the development of nonvisual techniques can sometimes cause some clients and others to misinterpret the purpose of the agency's approach to training, leaving them with the impression that staff members are opposed to the use of low-vision techniques and devices. The philosophy of the Nebraska Commission for the Blind and Visually Impaired actually promotes the use of low-vision techniques and devices when appropriate to achieve maximum independence. In fact, the agency was for many years a major sponsor of the low-vision clinic at the University of Nebraska Medical Center in Omaha and continues to purchase low-vision devices when appropriate for meeting the needs of clients. Also NSBVI field staff have received training in appropriate low-vision assessment techniques and services for working with agency clients, especially the senior blind.
Because vision is such a commonly used sense, has been such a part of the student's life, and has such social acceptance, the decision about when to introduce visual techniques to a student and still use structured discovery is critical. Introduce low-vision techniques too early and, because of social acceptance and personal familiarity, a student will focus on the visual techniques to the exclusion of nonvisual ones. When this happens, he or she will never really come to understand that it is possible to function without vision while using remaining vision to supplement and enhance alternative techniques. This focus on visually based techniques and devices can obscure the discovery that many activities are not best addressed using visual techniques, but that the majority of daily tasks are completed more efficiently, effectively, and safely using nonvisual alternatives.
Informed choice is a critical aspect of successful rehabilitation, and only a consumer who is fully knowledgeable about the complete range of possible nonvisual and low-vision alternative techniques can make a truly informed choice about which technique will best meet his or her needs in a given situation. The only way to be truly informed about nonvisual techniques is by developing a true mastery of these skills so that a fair comparison can be made with the more familiar visually based skills. The development of the new nonvisual alternatives is unlikely if the student is provided with appealing low-vision techniques before the nonvisual techniques are fully developed, since the consumer is likely to assume mistakenly that no further skill development is needed. For this reason the Nebraska Commission for the Blind and Visually Impaired emphasizes the development of nonvisual skills before low-vision alternatives are introduced. Throughout this process individual needs and abilities are considered, and the approaches to training are adjusted through informed choice so that these needs are most appropriately met.
Center training, for example, is a choice, which is intended to assist consumers to develop the highest level of proficiency in the complete complement of nonvisual skills, therefore low-vision training and devices are simply not a part of this program. A student who makes the choice to use low-vision-based alternatives has access, through the agency, to a qualified low-vision specialist, home-based instruction, and other training resources. Developing effective nonvisual techniques through structured-discovery learning can actually enhance an individual's use of low-vision because using nonvisual techniques like the long white cane to avoid obstacles can free the person's vision to locate useful landmarks at a distance or observe the movements of other pedestrians. Also the highly developed problem-solving skills that result from structured-discovery learning can directly improve an individual's ability to learn to use available visual information more efficiently and effectively.
Being blind really means that a person does not have reliable eyesight; therefore he or she needs to devise an effective and efficient set of alternative techniques in order to perform daily tasks successfully. People with some usable vision and a highly refined set of nonvisual skills can seamlessly transition from visually based techniques to those that do not require vision whenever conditions prevent use of their vision. Those who rely primarily on low-vision techniques may not have the ability to adapt effectively or safely to conditions that are poorly suited to the use of their limited eyesight. Rehabilitation is successful when our students leave training knowing both the alternative skills of blindness and the best way to optimize their remaining vision and so are able to integrate them into a skillset that makes dealing with blindness second nature, leaving our graduates empowered and ready to take on whatever challenges the world presents.