On the Duration of Sleepshade Training in the Adjustment to Blindness

By Justin M. Salisbury, MA, NOMC, NCRTB, NCUEB

Justin M. Salisbury is an Orientation and Mobility Therapist at Ho`opono Services for the Blind in Honolulu, Hawaii.

Abstract

A core component of the adjustment to blindness process is training, which ideally involves the use of sleepshades. This literature review investigates the reasons why sleepshade training typically lasts between six and nine months when attended on a full-time basis. The development of alternative techniques is often cited as the primary component of adjustment to blindness training, but the emotional adjustment is also critical and well-documented. The alternative techniques must be practiced until they become consistent and automatic and can be performed almost without thinking. The consistency and automaticity enable dependable problem solving and the development of problem-solving skills. Blind consumers must have enough experience under sleepshades to develop the confidence and feelings of normality that enable them to put their alternative techniques and problem-solving skills into action. Employment outcomes for consumers who undergo long-term sleepshade training appear more positive than employment outcomes for those who do not.

Keywords

Orientation and mobility, blindness rehabilitation, training, emotional adjustment, independence

Introduction

Autonomy in travel is a necessary component of maintaining a satisfactory quality of life for all human beings, blind or sighted (Golledge, 1993; Koutsoklenis & Papadopoulos, 2014). Independent travel skills can be a key element of a blind person’s success in both personal and professional arenas (Maurer, 2011). Simply acquiring blindness skills is not enough to achieve independence because the skills are the trappings of independence rather than the source of it. As Jernigan (1993) stated, “A slave can have keen eyesight, excellent mobility, and superb reading skills—and still be a slave.” Real independence comes from the emotional adjustment to blindness, the acquisition of self-esteem, and the understanding that one belongs in the world (Omvig, 2002). Students ideally conclude their adjustment to blindness training when they achieve competence and efficiency in their blindness skills, the self-confidence to execute them, a thorough understanding of their own positive attitude about their blindness, and an awareness of and ability to effectively handle public misconceptions (Tigges, 2004). Sixty-five years of combined professional experience suggests that this adjustment typically takes between six and nine months (Omvig, 2002; Tigges, 2004).

A review of existing literature seems to unearth two primary themes: (1) adjustment to blindness training is most effective when sleepshades are employed throughout the training process, and (2) this training typically requires six to nine months on a full-time basis in order for the student to reap the full benefits. These things appear to be true for many reasons. Sleepshade training helps students hone haptic and auditory perception. It helps students practice their skills to the point at which they become automatic. Students sharpen their nonvisual problem-solving skills. By developing nonvisual skills, students can more easily assess the value and optimize the use of their residual vision. Sleepshade training creates conditions promoting emotional adjustment to blindness. Students can role model nonvisual skills for each other, and an individual student can gradually take on more of a role model responsibility for classmates and other blind people as they progress through sleepshade training.

A person may properly be called a blind person when he has to devise so many alternative techniques to do efficiently those things which he would do if he were sighted that his pattern of daily living is substantially altered (Jernigan, 2005). A complete blindfold, also known as a pair of sleepshades, is an essential tool in the rehabilitation of every blind person (Olson, 1982; Omvig, 2002; Tigges, 2004). Even for people with progressive conditions, preparation for total blindness is only a minor part of the rationale for using sleepshades during rehabilitation training (Olson, 1982). The American Council of the Blind (2006) also believes that the use of sleepshades in the rehabilitation of people who are partially but not completely blind may have value.

In a study by Soong, Lovie-Kitchin, and Brown (2001), participants who were visually impaired or blind and had no previous orientation and mobility training were divided into two groups with matched pairs based on visual abilities. Participants were required to wear their habitual corrective lenses or other visual enhancements during their mobility assessment instead of wearing sleepshades. The experimental group was given orientation and mobility instruction, while the control group received no orientation and mobility instruction. These participants were selected from orientation and mobility referrals. The experimental group received anywhere from one hour to four full consecutive days of orientation and mobility training. Immediately prior to when this training began, participants were tested on their orientation and mobility skills. They were tested again four weeks after the pre-test, which allowed some elapsed time after the instruction. There was no improvement in mobility performance for the experimental group immediately after orientation and mobility training compared with a control group who did not receive training. This study demonstrated that the short-term orientation and mobility instruction involving the use of residual vision had no significant impact on the orientation and mobility skills of blind and visually impaired participants.

Perceptual Learning

Gibson (1969) explains that perception is the process by which we gather first-hand information about the world around us. Perceptual and cognitive skills are necessary for skill retention, transfer, and problem-solving (Dodds, 1985; Mettler, 1995/2008). Competent travelers devise strategies of encoding, processing, and retrieving environmental information (Kitchin & Blades, 2001; Koutsoklenis & Papadopoulos, 2014) through the process of perceptual learning. Blind people can use their remaining senses to perceive spatial information and then employ cognitive techniques to successfully travel (Guth, Rieser, & Ashmead, 2010; Koutsoklenis & Papadopoulos, 2011a, 2011b, 2014). In the cognitive paradigm of cane travel instruction, it is the student’s perception, not that of the instructor, which matters most (Mettler, 1995/2008). Dodds (1984) described the Structured Discovery learning experience to be one where the student is encouraged to interact with his or her own environment rather than being the recipient of sighted wisdom second-hand. Omvig (2002) explains that the process of developing the types of perceptual skills that blind travelers need requires repetition and experience.

Mettler (1995/2008) incorporates Gibson’s (1969) definition of perception and explains that perception is a process resulting from learning over time. Perception requires first-hand information derived from direct experience. It is impossible to truly tell people how to perceive their environment; they have to learn from experience how to perceive it. During effective blindness rehabilitation programs, instructors are looking for perceptual learning, which is an increase in the ability to extract information from the environment. The blind traveler has to be able to take in his or her own information and use it effectively.

Constantine (2002) describes reality as a perceptual field constructed and deconstructed by the individual in the context of their cultural group memberships. Parks (2000) describes a construct of imagination, through which individuals put together insights, ideas, and images in order to derive understanding and approximate truth. In stark contrast with fantasy, which is a journey into the unreal, imagination is a process of discovering what is real in the most personally significant ways. Imagination, or the process of deriving meaning, is based on the individuals’ socially constructed experiences (Tisdell, 2007). Therefore, for blind students in training, the ability to use imagination to perceive situations is likely to link their worldview with their progress in rehabilitation training and the overall adjustment to blindness. One’s perception of anything is a function of one’s own unique life experiences, and one is the sole authority on one’s own perception. A blind person needs to learn how to perceive and interpret environmental information nonvisually, and extensive sleepshade training can help him or her hone these abilities.

The Haptic System

The haptic experience refers both to experiencing movement and stationary objects (Koutsoklenis & Papadopoulos, 2014; Rodaway, 1994). Kinesthesia, the detection of the relative positions and movements of the parts of the body, is also a function of the haptic system (Gibson, 1966; Koutsoklenis & Papadopoulos, 2014). Since the haptic system keeps people in continuous contact with their environment, it can provide rich information to those who pay attention to it (Gibson, 1966). Haptic experience involves the whole body, not just the hands (Montagu, 1971). Feelings of pressure, vibration, temperature, and pain are all a part of the haptic experience because humans have nerves almost anywhere that they have skin (Heller & Schiff, 1991). Passive touch sensing, like what occurs when wind blows on one’s skin, provides environmental information (Gardiner & Perkins, 2005). When people react to their environment, this is part of the haptic system, as well (Boring, 1942).

Blind people obtain information through touch about the consistency, texture, and material of surfaces underfoot and about the direction and topographical layout of paths (Gardiner & Perkins, 2005). A cane is the most effective mobility device (Foulke, 1975). Dynamic touch is crucial to obtain useful environmental information (Gibson, 1962). Blind travelers have to be able to feel the reaction waves that travel up the shaft of the cane to gain information about the surface upon which the cane tip is being tapped or dragged (Brisben, Hsiao, & Johnson, 1999). Blind travelers can use the long white cane to gather information about breaks in a surface, texture, or the direction of grooves (Rodgers & Wall Emerson, 2005). Blind travelers can determine the distance to the ground simply by holding their canes and paying attention to the angle at which they hold their canes (Chan & Turvey, 1991). Ultimately, if a blind person wants to learn about his or her environment, the best way is to go explore it (Solomon, 1988; Turvey, Burton, Pagano, Solomon, & Runeson, 1992).

Being able to reliably detect drop-offs with a long white cane is an essential component of surface preview (Blasch, LaGrow, & De l’Aune, 1996), which is important for independent cane travel (Uslan & Schriebman, 1980) since missing drop-offs or other changes in elevation in the walking surface may impede smooth travel and even threaten the blind person’s safety (Kim & Wall Emerson, 2012). Training can generally improve human perceptual abilities (Platt & Racine, 1985; Recanzone, Merzenich, & Jenkins, 1992; Van Boven, Hamilton, Kauffman, Keenan, & Pascual-Leone, 2000). For example, Kim, Wall Emerson, and Curtis (2010) found that, with little to no training, the ability to detect drop-offs was significantly better with the constant contact technique than with the two-point touch technique, but, with practice, the difference in those perceptual abilities became negligible.

Kim, Wall Emerson, and Curtis (2009) compared study participants with more functional vision to participants with less functional vision in their abilities to detect drop-offs and found that, for smaller drop-offs, the participants with less functional vision were better able to detect smaller drop-offs. Since this study did not employ the use of sleepshades, and since these participants already had some experience using canes, some conclusions can easily be drawn. First, the participants with more functional vision were actually attempting to use that vision, and it was failing them. Second, the participants with less functional vision were detecting the drop-offs nonvisually with the use of the cane, which was effective. Third, the participants with less vision had been trained to detect drop-offs nonvisually. Fourth, the participants with less vision had more practice in those nonvisual techniques and would therefore perform better than those who were less experienced (Kim et al., 2010; Kim & Wall Emerson, 2012). Ultimately, blind people with more attuned haptic perception and skills fare better.

Auditory Perception

Maurer (2011) found that the reliance on low vision likely has a negative impact on the development of nonvisual skills, particularly in the area of auditory information processing for blind people. Nonvisual perception is necessary to bring in the information for decision-making. Blind pedestrians use sounds made by automobiles (Jacobson, 1993; LaGrow & Weessies, 1994). Blind travelers use traffic sounds to perform many key orientation tasks (Allen, Barbier, Griffith, Kern, & Shaw, 1997; Hill & Ponder, 1976; LaGrow & Weessies, 1994; Pogrund et al., 1995), such as aligning themselves correctly before street crossings (Guth, Hill, & Rieser, 1989; Willoughby & Monthei, 1998), as well as to self-monitor for veering while crossing a street (Allen et al., 1997; Hill & Ponder, 1976). Blind pedestrians also use traffic sounds to know when to cross streets (Hill & Ponder, 1976; Jacobson, 1993) and to monitor turning cars on the parallel street (Jacobson, 1993; LaGrow & Weessies, 1994). To do any of this, a blind pedestrian has to detect the vehicle in order to begin an appropriate decision-making process (Lawson & Wiener, 2010). Target sounds are always detected against background ambient noise (Macmillan & Creelman, 2004), so this perceptual skill must be developed. Kim, Wall Emerson, Naghshineh, and Myers (2014) found that blind pedestrians prefer to make street crossings in situations of less background ambient noise. Finally, Maurer (2011) also found that auditory information is used heavily by strong cane travelers.

Maurer, Bell, Woods, and Allen (2006) explain that students and instructors with any vision at all wear sleepshades while they learn to block out any remaining vision. Students with residual vision tend to use that vision as the primary sense when traveling, but the goal in cane travel is for the student to learn nonvisual techniques. Residual vision often hinders learning. Whether done consciously or subconsciously, vision interferes with the student’s ability to put together the knowledge and skills of nonvisual travel. Students become fatigued both physically and mentally from trying to use their vision while traveling. Continuous scanning for obstacles and other environmental information is physically fatiguing, and continuing to use old skills while simultaneously trying to acquire and integrate new skills is mentally fatiguing. Sleepshades reduce both fatigue and distraction, so students are better able to focus, boosting the quality and efficiency of their learning of the skills of nonvisual cane travel. More broadly, sleepshade training supports the development of auditory information processing and related nonvisual skills, which blind people need to be successful.

Automaticity

Skills which are practiced until they can be executed automatically and without significant conscious effort have reached the level of automaticity (Mettler, 1995/2008). Mettler also explains that as basic techniques become more automatic and dependable, the traveler’s attention is freed up to focus on perceptual awareness, problem solving, strategy planning, self-assessment, and error detection. In Structured Discovery Cane Travel, skills that are to reach automaticity include basic cane techniques, walking in step, and orienting oneself according to parallel traffic. Highly skilled cane travelers have practiced many behaviors to automaticity, enabling them to consciously delegate a wide array of behaviors to the subconscious (Maurer et al., 2006), thus leaving their conscious mind available for other tasks (Maurer, 2011). The Code of Professional Ethics of the National Blindness Professional Certification Board (NBPCB) (2006) holds that instructors must understand that mere knowledge of techniques is insufficient and that complete mastery is necessary.

Low confidence or a lack of practice can go so far as to produce a slow or irregular gait (Jerome & Albright, 2011), which disrupts travel and creates a negative cycle. On the other hand, training can improve the skills that support perception to the point of automaticity (Platt & Racine, 1985; Recanzone et al., 1992; Van Boven et al., 2000). Vibrotactile skills, which enable the acquisition of information about surfaces through the cane, are acquired through practice (Fleishman & Rich, 1963; Morford, 1966; Sims & Morton, 1998). Vibrotactile skills may enable more experienced cane users to detect drop-offs much more effectively than new cane users (Kim, Wall Emerson, & Curtis, 2009).

In one study, Maurer (2011) began to describe the defining characteristics of highly-skilled cane travelers. Skilled cane travelers were identified by leaders in the National Federation of the Blind, and their behaviors were observed. The researcher employed running records to document participant behaviors and think aloud protocols and miscue analysis to analyze the thinking behind the behaviors. The participants were observed in both familiar and unfamiliar travel environments. Participants were allowed to choose a familiar setting, and a shopping mall was selected for the unfamiliar setting. Each participant verified that the specific mall was indeed unfamiliar to them. The highly-skilled travelers all demonstrated the following common characteristics: highly automatic routine travel skills, making errors despite the fact that they were excellent travelers, and the ease and smoothness with which they corrected and recovered from errors. The researcher keyed in on a level of consciousness in cane travel which exists between the conscious and the subconscious. Participants seemed to be experiencing a preconscious state as explained by Freud (1964), where they would shift back and forth between the conscious and subconscious mind for different travel tasks. For those tasks practiced to a level of automaticity, travelers were able to use their subconscious, but problem-solving processes were performed in the conscious mind. These findings appear to gel with Mettler’s (1995/2008) notion that automaticity makes information more dependable and helps problem-solving to become more automatic. Sleepshade training must last long enough for the student to reach a substantial level of automaticity with nonvisual skills and also learn how to take advantage of the benefits that come from that automaticity.

Developing Problem-Solving Skills

Mettler (1995/2008) discusses the cognitive problem-solving component of blindness rehabilitation. Students must first have experiences which enable them to learn basic problem-solving principles and then ideally advance to the development of metacognitive skills, which involve thinking about thinking. Students must develop a solid understanding of their own thinking processes, which includes understanding strengths and weaknesses, and then learn how to actively manage their thinking style. Those who are trained in metacognition are more adaptable learners and, as a result, are more empowered and experience a more internalized locus of control. The knowledge necessary for managing perceptual awareness and cognitive problem solving in cane travel cannot simply be passed down from an instructor to a student. Thus, acquiring this knowledge requires learning by making mistakes and overcoming them. If a student encounters problems in cane travel as a result of underdeveloped perceptual awareness or inaccurate assumptions, the student is much better equipped to address those problems because those problems are a function of the student’s perceptual experience. The instructor does not have true insider access to those assumptions and how they have been applied, so the student has the advantage in problem-solving. The same is also true for the relative significance judgements that the students have made about the landmarks and other cues which they have encountered. The student must learn how to identify the cause of the cognitive or perceptual error. The process of identifying and correcting errors must occur within the student’s cognitive structure and style, which makes it sustainable and transferrable. The construction of knowledge occurs through active assimilation rather than being uploaded into the student. Sleepshade training must last long enough for students to have enough problem-solving opportunities to manage their own styles through metacognition.

Optimal Use of Residual Vision

Students with residual vision at Structured Discovery training centers are required to wear sleepshades throughout the training day but not after hours (Altman, 2012; Omvig, 2002). Students with usable vision tend to use it when they are not wearing their sleepshades (Mettler, 1997; Olson, 1982). During the time that their sleepshades are off, students learn to build their own unique complete set of optimal techniques, some of which are visual, and some of which are nonvisual, which is just as important as the complete set of nonvisual techniques (Altman, 2012; Mettler, 1997; Olson, 1982). The only way for students to really judge the efficiency and effectiveness of the nonvisual techniques they are learning is to practice them constantly under sleepshades until these skills become habitual (Olson, 1982; Omvig, 2002; Tigges, 2004). Sleepshade training must last long enough that students can maximize the efficiency of their nonvisual skills, which allows them to accurately compare the efficiency of nonvisual skills versus visual skills, thus using residual vision only when it truly is most efficient.

Having Role Models

In the training center environment, students should enter and exit the program on individual schedules (Tigges, 2004), so there will always be a hierarchy from less advanced students to more advanced students (Omvig, 2002). Throughout a student’s training process, until near the very end, there will always be other students who are more advanced in their blindness training who can role model for the blind student in question. Additionally, the staff at the training center must include a significant representation of successful blind adults who have achieved competitive employment prior to working at the center (Omvig, 2002). Role modeling is a strong form of social persuasion, one of Bandura’s (1997) primary sources of self-efficacy, which is what students must achieve in blindness training (Omvig, 2002). When students notice the successes of other blind people, it makes it more realistic for them to believe those successes to be possible for themselves (Morais et al., 1997). More exposure to successful blind people is associated with one having a more positive attitude about blindness (Rowland & Bell, 2012). The same study also indicated that more personal experience and awareness of the level of independence that blind people can readily achieve helps build positive attitudes and expectations for blind people (Rowland & Bell, 2012). Even sighted instructors must achieve expertise under sleepshades in order to role model for their students (Omvig, 2002). Sleepshade training puts students in a position to accept role modeling from others using purely nonvisual skills.

Being a Role Model

Newly blind people, or blind people without good blindness training, will be likely to hold all the same misperceptions and low expectations that pervade the general public. Advanced students in blindness training have the opportunity to give back, a process which helps the advanced student achieve a greater sense of normality in society (Omvig, 2002). Proficiency in nonvisual travel is necessary to role model it (Aditya, 2004). Role models may still be susceptible to problematic attitudes about blindness (Gillies, Knight, & Baglioni, 1998; Thurman, 1983), so it is an opportunity for those role models to reinforce their own understandings while having the good feelings associated with giving back (Omvig, 2002). For example, at a residential adjustment to blindness program in Maryland, each student must select, plan, organize, and lead a group social outing, such as a group trip to play paintball (Kozlowski, 2013). These activities serve both as an opportunity to build the confidence of the role model student and the newer, disciple students. Sleepshade training must last long enough for students to transition from the ultimate novice to the role model with nonvisual skills.

Achieving Emotional Adjustment

The overarching objective of blindness training is to bring the blind consumer to come emotionally to understand his or her own normality and capacity for independence and self-sufficiency (NBPCB, 2006). Olson (1981) and Omvig (2002) describe a hierarchy of sight, an inaccurate but widespread belief that one’s productivity, normality, and quality of life are inherently and directly correlated with the amount of vision a person has. The American general public fears blindness only third to Auto Immune Deficiency Syndrome (AIDS) and cancer (Aditya, 2004). Many believe that vision is the most powerful sense for perceiving spatial information (Gibson, 1979; Koutsoklenis & Papadopoulos, 2014), so a blind person would inherently be at a significant disadvantage if that were true. Courington, Lambert, Becker, Ludlow, and Wright (1983) found that blind people had internalized the negative stereotypes about blindness. Since students generally adopt the misperceptions and low expectations in society prior to their training, it is important that those problems be addressed during their training (Altman & Cutter, 2004; Omvig, 2002). Promoting positive views toward blindness in the blind and sighted alike is an irreplaceable component of any educational or rehabilitation program (Rowland & Bell, 2012). A substantial emotional adjustment to blindness is necessary for blind individuals to compete successfully in a predominantly sighted world (Aditya, 2004; Olson, 1982; Omvig, 2002; Tigges, 2004). Sleepshade training has to last long enough to facilitate that emotional adjustment.

In an interview-based qualitative study, Schroeder (1996) provided a thorough investigation of the meaning of Braille to eight legally blind adults. Self-esteem, self-identity, and the perceived stigma of being a blind person were found to be related to the participants’ expressed feelings about Braille. The study found that those participants who had put in the time and effort to master Braille literacy and continued to use it had developed a stronger sense of identity marked by competence, equality, and independence. Those participants who reported neutral feelings about Braille had significant amounts of residual vision and did not identify as blind people. They felt pressure to function like their sighted peers and devalued themselves when they could not. Since they considered themselves less disabled, they did not embrace the alternative techniques of using Braille, which prevented them from reaching the same levels of independence as those who took the time to master Braille skills and incorporate them into their daily lives. Braille itself facilitates the development of confidence and group identification with other blind people. For those participants who had not invested in the development and maintenance of blindness skills and the confidence therein, it was common to devalue activities that they did not have enough vision to do visually. Ultimately, the participants who were committed to using blindness skills and saw themselves as blind people were less limited than those who held out in favor of clinging to their residual vision. Since it takes time and effort to master Braille literacy or at least get one’s Braille skills to the point of being useful on a daily basis, training must last long enough to help students achieve such a level. This also helps maintain that group identification.

The Code of Professional Ethics of the NBPCB (2006) states that blind people are members of a visible and identifiable minority and, as a result, the primary problem faced by blind people is not medical but attitudinal; misconceptions run rampant in the general public. These misunderstandings about blindness lead to beliefs and feelings of inferiority. Though socially constructed instead of factual, they persist in society and in the emotions of blind consumers. Consequently, all adjustment to blindness services must teach the blind consumers that the prevailing views about blindness are wrong and harmful, helping them to create their own constructive and positive attitudes. As Jernigan (1993) expressed, the blind consumer must come to understand that alternative techniques and skills of blindness are not ends but are actually means to deliver the true independence that comes from the emotional adjustment. Training purely in the skills of blindness but ignoring or otherwise failing to achieve the emotional adjustment deprives the blind person of the opportunity to fully capitalize on the skills acquired. The blind consumer is likely to fall into the trap of thinking that they have completed their adjustment process and accept as inherent consequences of blindness itself the limitations that they still face (Omvig, 2002). If blind students are dismissed from sleepshade training too early, they are not fully equipped to conquer these hurdles.

Silverman (2014) discusses the impacts of special privileges for the blind on emotional adjustment and freedom. A blind person’s sense of self-respect can be undermined by accepting special treatment. Accepting extra help encourages dependency and hinders growth. Blind people who are always getting help never find out if they can handle the attempted tasks independently. Part of the adjustment to blindness process is learning to decline help in order to figure out how to do something independently. Learning how to decline special treatment helps blind people become responsible and competent contributors in society. Sleepshade training must last long enough to get students in a rhythm of declining unnecessary help and understanding what they can really do independently.

Silverman, Gwinn, and Van Boven (2015) found that short-term experiential simulation of blindness leads people to judge blind people as less capable. This article reported that an experimental group who experienced short-term blindness simulations demonstrated less belief in blind people than a control group which performed the same tasks without the blindfold and an experimental group which only watched others experience blindness simulation. These results conflict with the widely-supported belief that simulating the experiences of others improves attitudes toward those people. The article explains that, when people encounter failure and challenging experiences upon becoming temporarily blinded, they tend to extrapolate that experience as an inherent reality that would occur if they actually became blind. Instead of creating more positive views toward the blind, the simulation experience actually engendered more paternalistic and sympathetic views toward the blind. If a person experiencing vision loss receives short-term sleepshade training, he or she would be likely to fear further vision loss and develop counterproductive feelings about blindness.

Silverman (2015) discusses the dangers of short-term blindness simulations. For a blind person with residual vision, putting on a pair of sleepshades is simulating total blindness; the duration of the sleepshade training is the duration of the simulation of total blindness. Blindness simulations frequently mislead people about the realities of total blindness because they often lead people to focus on the initial trauma of becoming totally blind rather than the real experience of being a blind person. Blind people do not start over from the beginning of blindness at the beginning of every day; the life experiences of blind people are cumulative, just like those of sighted people. In order for blindness simulation to be beneficial, it must include hands-on training in blindness skills and meaningful contact with blind people. In order to be effective, producing a sense of confidence, the training must last long enough to include skill repetition and practice and be led by competent instructors. People eventually adapt to new disabilities through the acquisition of alternative techniques and positive support networks (Ubel, Loewenstein, & Jepson, 2005), which is part of the benefit of sleepshade training. Short-term simulations cannot offer exposure to these long-term adjustments, so they can lead participants to believe that life as a blind person is characterized by loss, frustration, and incompetence. Short-term simulations often deceive participants into thinking they understand what it is like to live with that disability. The negativity toward disability created by these simulations is significantly different than the attitudes of well-adjusted disabled people. Because disability simulations are escapable, participants in short-term simulations do not have ample time to understand the impacts of social discrimination and accessibility barriers. These impacts can only become apparent over time (French, 1992). Personal experience shapes people’s beliefs about conditions like blindness. If people have a simulated blindness experience where they are afraid, frustrated, and incompetent, they are likely to conclude that blind people’s lives are just like that experience. This precipitates low expectations of blind people and even paternalistic actions to shelter blind people from fear and helplessness, thus reinforcing the hierarchy of sight. On the other hand, blindness experiences characterized by mastery, pride, and joy precipitate high expectations and strong understanding of the alternative techniques of blindness. Silverman (2015) concludes by highlighting the urgent need for research to assess the effectiveness of blindness training programs on attitudes about blindness. Sleepshade training must last long enough to help students push through the experiences of helplessness, confusion, painfully accepted second-class citizenship, and fear in order to eventually feel empowered; if training ceases too early, the student may be left with the residue of these counterproductive feelings.

Consequences for Employment

Ryles (1996) demonstrated that Braille literacy made blind people dramatically more employable. Kirchner, Johnson, and Harkins (1997) found that blind people themselves were well aware of the consequences of poor travel skills. Crudden, McBroom, Skinner, and Moore (1998) found that 67% of blind people surveyed identified transportation skills as a major barrier to employment. Employment remains “an elusive goal” for most blind people (Kirchner et al., 1997). Kirchner and Peterson (1979), as well as Schroeder (1989), estimated the unemployment rate of the blind to be 70 percent. Kirchner et al. (1997) found that work orientation made all the difference. There was also, though, a substantial part of the sample that was legitimately interested and unemployed. Kirchner and Smith (2005) described a long-standing problem of high expectations for the education of blind youths but low payoff in employment and earnings. In either case, the lack of confidence that comes from internalizing the low expectations in society can lead any blind person off the employment path. As students gain self-confidence and more positive attitudes about their blindness, they raise their expectations of their own capabilities, precipitating vocational goals which are more fulfilling and more likely to be achieved (Tigges, 2004).

Bell and Mino (2015) provided the largest field-based study in the area of rehabilitation for blind and visually impaired individuals, with a national sample of 1,056 participants. This study indicated that 37 percent of working-age blind or visually impaired adults were employed full-time and earned a median salary of $35,000 per year. Obtaining comprehensive adjustment to blindness training was positively related to employment outcomes. Participants who received comprehensive adjustment to blindness training from Structured Discovery-based programs, including sleepshades, touted a 60 percent employment rate and mean annual earnings of $49,300; by contrast, those trained at conventionally-based programs carried an employment rate of 47 percent and mean annual earnings of $38,100. Recidivism was negatively related to employment. Participants who received training at least four times demonstrated only a 35 percent employment rate in comparison to one-time training attendees touting a 57 percent employment rate. Those who sought training only once reported $13,000 higher mean annual earnings. Participants who used a white cane for mobility daily had a higher employment rate and mean annual earnings than those who no longer did. Participants who read Braille daily or weekly had a significantly higher employment rate and mean annual earnings than those who did not. This study demonstrates that blind people who receive sleepshade training for six to nine months, a hallmark of Structured Discovery training centers, achieve superior employment outcomes to those who do not, and such training may precipitate continued cane and Braille usage.

Implications for Practitioners and Families

There is much documentation on the types of alternative techniques which a blind person must develop in order to function nonvisually. Students in training must learn how to interpret environmental information and also how to interact with their environment. Indeed, these skills are important and take time to develop through adjustment to blindness training using sleepshades. If the skills are practiced to the level of automaticity, then the person’s intellectual resources are freed up to be devoted to other things, one of which can be problem-solving processes. As mastery of alternative techniques and problem solving skills increase, the ongoing process of emotional adjustment begins to assume the primary focus of the adjustment to blindness process.

In the general public, there are vast misperceptions and low expectations of blind people, and the students in adjustment to blindness training need time to address them and learn how to address them on their own after training. Since blind people are members of a minority, they must come to develop a sense of identity as a blind person and to be confident in themselves with that identity. Feelings of normality, confidence, and self-efficacy must be cultivated in order to sustain the simple technical progress and put it into action. Students must have the opportunity to build up to a level of success with their blindness training that will reinforce self-efficacy instead of the feelings of helplessness which are commonly experienced at the very onset of blindness. Students need enough time to be able to learn how to deal effectively with social discrimination and accessibility barriers. History demonstrates that it typically takes six to nine months for this emotional adjustment to take place. When students stay committed to training under sleepshades long enough to reap all of the benefits, especially the emotional adjustment, they get better employment outcomes than those who do not. Consumers who have not experienced the long-term training under sleepshades at a training center anchored in the Structured Discovery approach should strongly consider it. Consumers considering training should plan to attend for at least six to nine months in order to obtain the full benefit and expect that feelings of confidence and normality are achievable.

Implications for Future Research

There still remains room for future research. There is little research on why it is not necessary or ideal for adjustment to blindness training to last, on average, longer than six to nine months. Since self-efficacy is built, in part, by overcoming challenges, it may be necessary to move onto the next chapter in one’s rehabilitation process, with new challenges, in order to maintain an optimal level of challenge and stimulation. Once a student has mastered the alternative techniques and sharpened his or her problem-solving skills, further training would no longer be stimulating. Also, if a student expected to spend a longer period of time in training, there would be less pressure and incentive to progress in the shorter period of time. This could simply slow down the tempo, which might violate an important part of building up a blind person’s stamina to help them enter or re-enter the competitive workforce.

There could also be value in research on the importance of continuity rather than breaking up training over an extended period of time. Comprehensive adjustment to blindness training is routinely performed on a full-time basis, but there is room for more research investigating the consequences of breaking up training into intensive periods, such as what might happen if a college student attended such training only during the summers. This model could have the same risks as training recidivism, but perhaps the pre-planned nature of such training would enable different results. Similar research could focus on the mechanisms and steps which would best support a student to make the most of such training, such as interaction with blind role models and independent efforts to retain or continue the progress in skill mastery and confidence development.

The length of a student’s training day appears to be related to stamina development, but there could be value to research investigating the impact on skill acquisition and emotional adjustment, as well. If an adjustment to blindness training program were to adopt a six-hour training day versus an eight-hour training day, the program may produce different results. Similarly, there could be a noteworthy difference between a ten-hour training day and an eight-hour training day. These differences could be investigated and documented.

The existing literature appears to point to the emotional adjustment to blindness as the primary driver of the duration of the sleepshade training, but there is still more room for research investigating the different dimensions of emotional adjustment to blindness which blind people may need. Some of the needs for emotional adjustment may be individualized based on life experience and worldview, but others may be universal. People who are born blind may have a different adjustment process than people who become blind later in life, and age of onset may impact what types of adjustments a person may need to make. To someone who is born blind, blindness is the only reality that the person knows, but dealing with public misperceptions is still necessary. More research can take a deeper dive into the dimensions of emotional adjustment.

References

Aditya, R. N. (2004). A comparison of two orientation and mobility certifications. Washington, DC: National Institute on Disability and Rehabilitation Research.

Allen, W., Barbier, A. C., Griffith, A., Kern, T., & Shaw, C. (1997). Orientation and mobility teaching manual (2nd ed.). New York, New York: New York Infirmary Center for Independent Living.

Altman, J. T. (2012). When the sleep-shades aren’t on. Journal of Blindness Innovation and Research, 2(1). Retrieved from https://nfb.org/images/nfb/publications/jbir/jbir12/jbir020102abs.html. doi: http://dx.doi.org/10.5241/2F2-30

Altman, J., & Cutter, J. (2004). Structured Discovery Cane Travel. In D. Dew & G. Alan (Eds.), Contemporary issues in orientation and mobility: 29th IRI 2004, Institute on Rehabilitation (pp. 65-92). Washington, DC: George Washington University.

American Council of the Blind. (2006). Whitepaper on rehabilitation and training. Retrieved from http://acb.org/content/whitepaper-rehabilitation-and-training.

Bandura, A. (1997). Self-efficacy. Harvard Mental Health Letter, 13(9), 4-7.

Bell, E. C., & Mino, N. M. (2015). Employment Outcomes for Blind and Visually Impaired Adults. Journal of Blindness Innovation and Research, 5(2). Retrieved from https://nfb.org/images/nfb/publications/jbir/jbir15/jbir050202.html. doi: http://dx.doi.org/10.5241/5-85

Blasch, B. B., LaGrow, S. J., & De l'Aune, W. R. (1996). Three aspects of coverage provided by the long cane: Object, surface, and foot-placement preview. Journal of Visual Impairment & Blindness, 90(4), 295-301.

Boring, E. G. (1942). Sensation and perception in the history of experimental psychology. New York, New York: Appleton-Century-Crofts.

Brisben, A. J., Hsiao, S. S., & Johnson, K. O. (1999). Detection of vibration transmitted through an object grasped in the hand. Journal of Neurophysiology, 81(4), 1548-1558. Retrieved from http://jn.physiology.org/content/81/4/1548.

Chan, T.-C, & Turvey, M. T. (1991). Perceiving the vertical distances of surfaces by means of a hand-held probe. Journal of Experimental Psychology: Human Perception and Performance, 17(2), 347-358. doi: http://dx.doi.org/10.1037/0096-1523.17.2.347.

Constantine, M. G. (2002). The intersection of race, ethnicity, gender, and social class in counseling: Examining selves in cultural contexts. Journal of Multicultural Counseling and Development, 30(4), 210–215. doi: 10.1002/j.2161-1912.2002.tb00520.x

Courington, S. M., Lambert, R. W. Jr., Becker, S., Ludlow, L. H., & Wright, B. D. (1983). The measurement of attitudes toward blindness and its importance for rehabilitation. International Journal of Rehabilitation Research, 6(1), 67-71.

Crudden, A., McBroom, L. W., Skinner, A. L., & Moore, J. E. (1998). Comprehensive Examination of Barriers to Employment among Persons Who Are Blind or Visually Impaired. Mississippi State, Mississippi: Mississippi State University Rehabilitation Research and Training Center on Blindness and Low Vision. Retrieved from http://files.eric.ed.gov/fulltext/ED419309.pdf

Dodds, A. G. (1984). A report to R.N.I.B. on a visit to Nebraska Services for the Visually Impaired (Report No. 138). Nottingham, England: Blind mobility research unit, University of Nottingham.

Dodds, A. G. (1985). Mobility: Blind instructors? New Beacon, 69(817), 137-139.

Fleishman, E. A., & Rich, S. (1963). Role of kinesthetic and spatial-visual abilities in perceptual-motor learning. Journal of Experimental Psychology, 66, 6-11.

Foulke, E. (1975). The development of an improved cane for use by blind pedestrians. In Annual report to the Dean of the Graduate School: [on the] Perceptual Alternatives Laboratory, a graduate research institute of the University of Louisville. Louisville, Kentucky: The Laboratory (pp. 57-69).

French, S.  (1992). Simulation exercises and disability awareness training: A critique. Disability, Handicap and Society, 7(2), 257-266. doi: 10:1080/02674649266780261

Freud, S. (1964). The unconscious. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 14, pp. 166-215). London, England: Hogarth Press. (Original work published 1915)

Gardiner, A., & Perkins, C. (2005). 'It's a sort of echo…': Sensory perception of the environment as an aid to tactile map design. British Journal of Visual Impairment, 23(2), 84-91. doi: 10.1177/0264619605054780

Gibson, E. J. (1969). Principles of Perceptual Learning and Development. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.

Gibson, J. J. (1962). Observations on active touch. Psychological Review, 69(6), 477-491.

Gibson, J. J. (1966). The senses considered as perceptual systems. Boston, Massachusetts: Houghton Mifflin.

Gibson, J. J. (1979). The ecological approach to visual perception. Boston, Massachusetts: Houghton Mifflin.

Gillies, R. M., Knight, K., & Baglioni Jr, A. J. (1998). World of work: Perceptions of people who are blind or vision impaired. International Journal of Disability, Development and Education, 45(4), 397-409.

Golledge, R. G. (1993). Geography and the disabled: A survey with special reference to vision impaired and blind populations. Transactions of the Institute of British Geographers, 18(1), 63-85. doi: 10.2307/623069

Guth, D. A., Hill, E. W., & Rieser, J. J. (1989). Tests of blind pedestrians' use of traffic sounds for street-crossing alignment. Journal of Visual Impairment & Blindness, 83(9), 461-468.

Guth, D. A., Rieser, J. J., & Ashmead, D. H. (2010). Perceiving to move and moving to perceive: Control of locomotion by students with vision loss. In W. R. Wiener, R. L. Welsh, & B. B. Blasch (Eds.), Foundations of orientation and mobility (3rd Ed., Vol. 1, pp. 3-44). New York, New York: AFB Press.

Heller, M. A., & Shiff, W. (1991). The psychology of touch. Hillsdale, New Jersey: Lawrence Erlbaum Associates.

Hill, E. W., & Ponder, P. (1976). Orientation and mobility techniques: A guide for the practitioner. New York, New York: American Foundation for the Blind.

Jacobson, W. H. (1993). The art and science of teaching orientation and mobility to persons with visual impairments. New York, New York: American Foundation for the Blind.

Jernigan, K. (1993). The nature of independence: An address delivered at the annual convention of The National Federation of the Blind, Dallas, Texas, Tuesday, July 6, 1993. Retrieved from http://www.nfb.org/Images/nfb/Publications/convent/addres93.htm.

Jernigan, K. (2005). A definition of blindness. Future Reflections, 24(3). Retrieved from https://nfb.org/images/nfb/publications/fr/fr19/fr05si03.htm.

Jerome, G. J., & Albright, C. (2011). Accuracy of five talking pedometers under controlled conditions. Journal of Blindness Innovation and Research, 1(2). Retrieved from https://nfb.org/images/nfb/publications/jbir/jbir11/jbir010203abs.html. doi: http://dx.doi.org/10.5241/2F1-17.

Kim, D. S., & Wall Emerson, R. (2012). Effect of cane length on drop-off detection performance. Journal of Visual Impairment & Blindness, 106(1), 31-35.

Kim, D. S., Wall Emerson, R., & Curtis, A. (2009). Drop-off detection with the long cane: Effects of different cane techniques on performance. Journal of Visual Impairment & Blindness, 103(9), 519-530.

Kim, D. S., Wall Emerson, R., & Curtis, A. (2010). Interaction effects of the amount of practice, preferred cane technique, and type of cane technique used on drop-off detection performance. Journal of Visual Impairment & Blindness, 104(8), 453-463.

Kim, D. S., Wall Emerson, R., Naghshineh, K., & Myers, K. (2014). Influence of ambient sound fluctuations on the crossing decisions of pedestrians who are visually impaired: Implications for setting a minimum sound level for quiet vehicles. Journal of Visual Impairment & Blindness, 108(5), 368-383.

Kirchner, C., Johnson, G., & Harkins, D. (1997). Research to improve vocational rehabilitation: Employment barriers and strategies for clients who are blind or visually impaired. Journal of Visual Impairment & Blindness, 91(4), 377-392.

Kirchner, C., & Peterson, R. (1979). Statistical Brief #5—Employment: Selected characteristics. Journal of Visual Impairment & Blindness, 73(6), 239-242.

Kirchner, C., & Smith, B. (2005). Transition to what? Education and employment outcomes for visually impaired youths after high school. Journal of Visual Impairment & Blindness, 99(8), 499-503.

Kitchin, R., & Blades, M. (2001). The cognition of geographic space. London, England: I. B. Tauris.

Koutsoklenis, A., & Papadopoulos, K. (2011a). Auditory cues used for wayfinding in urban environments by individuals with visual impairments. Journal of Visual Impairment & Blindness, 105(10), 703-714.

Koutsoklenis, A., & Papadopoulos, K. (2011b). Olfactory cues used for wayfinding in urban environments by individuals with visual impairments. Journal of Visual Impairment & Blindness, 105(10), 692-702.

Koutsoklenis, A., & Papadopoulos, K. (2014). Haptic cues used for outdoor wayfinding by individuals with visual impairments. Journal of Visual Impairment & Blindness, 108(1), 43-54.

Kozlowski, J. C. (2013). Blind paintballers disability discrimination claim. Parks & Recreation, 48(4), 28-33.

LaGrow, S. J., & Weessies, M. J. (1994). Orientation and mobility: Techniques for independence. Palmerston North, New Zealand: Dunmore Press.

Lawson, G. D., & Wiener, W. R. (2010). Audition for students with vision loss. In W. R. Wiener, R. L. Welsh, & B. B. Blasch (Eds.) Foundations of orientation and mobility, (3rd ed., Vol. 1, pp. 84-137). New York, New York: AFB Press.

Macmillan, N. A., & Creelman, C. D. (2005). Detection theory: A user’s guide (2nd ed.). Mahwah, New Jersey: Lawrence Erlbaum Associates.

Maurer, M. M. (2011). Examining highly skilled cane travelers: A preliminary study. Journal of Blindness Innovation and Research, 1(2). Retrieved from https://nfb.org/images/nfb/publications/jbir/jbir11/jbir010202abs.html. doi: http://dx.doi.org/10.5241/2F1-5

Maurer, M. M., Bell, E. C., Woods E., & Allen. R. (2006). Structured discovery in cane travel: Constructivism in action. Phi Delta Kappan, 88(4) 304-307. doi: 10.1177/003172170608800412

Mettler, R. (1997). The cognitive paradigm for teaching cane travel. American Rehabilitation, 23(3), 18-23.

Mettler, R. (2008). Cognitive learning theory and cane travel instruction: A new paradigm (2nd ed.). Lincoln, Nebraska: Nebraska Commission for the Blind and Visually Impaired. (Original work published 1995)

Montagu, A. (1971). Touching: The human significance of the skin. New York, New York: Harper and Row.

Morais, M., Lorensen, P., Allen, R., Bell, E. C., Hill, A., and Woods, E. (1997). Techniques used by blind cane travel instructors. National Federation of the Blind: Baltimore, Maryland.

Morford, W. R. (1966). The value of supplementary visual information during practice on dynamic kinesthetic learning. Research Quarterly, 37(3), 393-405.

National Blindness Professional Certification Board. (2006). Code of professional ethics. Ruston, Louisiana: National Blindness Professional Certification Board.

Olson, C. (1982). On the use of the blindfold. Lincoln, Nebraska: Nebraska Department of Public Institutions, Division of Rehabilitation Services for the Visually Impaired.

Omvig, J. H. (2002). Freedom for the blind: The secret is empowerment. Fayetteville, Arkansas: Region VI Rehabilitation Continuing Education Program, University of Arkansas (Reprinted in 2005 by National Federation of the Blind, Baltimore, MD).

Parks, S. D. (2000). Big questions, worthy dreams: Mentoring young adults in their search for meaning, purpose, and faith. San Francisco, California: Jossey-Bass.

Platt, J. R., & Racine, R. J. (1985). Effect of frequency, timbre, experience, and feedback on musical tuning skills. Perception & Psychophysics, 38(6), 543–553. doi: 10.3758/BF03207064

Pogrund, R., Healy, G., Jones, K., Levack, N., Martin-Curry, S., Martinez, C., ... & Vrba, A. (1995). Teaching age-appropriate purposeful skills: An orientation and mobility curriculum for students with visual impairments. Austin, Texas: Texas School for the Blind and Visually Impaired.

Recanzone, G. H., Merzenich, M. M., & Jenkins, W. M. (1992). Frequency discrimination training engaging a restricted skin surface results in an emergence of a cutaneous response zone in cortical area 3a. Journal of Neurophysiology, 67(5), 1057–1070.

Rodaway, P. (1994). Sensuous geographies: Body, sense and place. London, England: Routledge.

Rodgers, M. D., & Wall Emerson, R. (2005). Human factor analysis of long cane design: Weight and length. Journal of Visual Impairment & Blindness, 99(10), 622-632.

Rowland, M. P., & Bell, E. C. (2012). Measuring the attitudes of sighted college students toward blindness. Journal of Blindness Innovation and Research, 2(2). Retrieved from https://nfb.org/images/nfb/publications/jbir/jbir12/jbir020202abs.html. doi: http://dx.doi.org/10.5241/2F2-24

Ryles, R. (1996). The impact of braille reading skills on employment, income, education, and reading habits. Journal of Visual Impairment and Blindness, 90, 219-226. Retrieved from http://mountbattenbrailler.com/Docs/papers/Ryles_study.pdf.

Schroeder, F. (1989). Literacy: The key to opportunity. Journal of Visual Impairment & Blindness, 83(6),290-293.

Schroeder, F. K. (1996). Perceptions of braille usage by legally blind adults. Journal of Visual Impairment & Blindness, 90(3), 210-218.

Silverman, A. (2014). On long lines and tax breaks: A mindful approach to special blindness benefits. Future Reflections, 33(3). Retrieved from https://nfb.org/images/nfb/publications/fr/fr33/3/fr330312.htm.

Silverman, A. M. (2015). The Perils of Playing Blind: Problems with Blindness Simulation, and a Better Way to Teach About Blindness Section. Journal of Blindness Innovation and Research, 5(2). Retrieved from https://nfb.org/images/nfb/publications/jbir/jbir15/jbir050201.html. doi: http://dx.doi.org/10.5241/5-81

Silverman, A. M., Gwinn, J. D., & Van Boven, L. (2015). Stumbling in their shoes: Disability simulations reduce judged capabilities of disabled people. Social Psychological and Personality Science, 6(4), 464-471. doi: https://doi.org/10.1177/1948550614559650

Sims, K., & Morton, J. (1998). Modelling the training effects of kinaesthetic acuity measurement in children. Journal of Child Psychology and Psychiatry, 39(5), 731-746.

Solomon, H. Y. (1988). Movement-produced invariants in haptic explorations: An example of a self-organizing, information-driven, intentional system. Human Movement Science, 7(2-4), 201-223. doi: http://dx.doi.org/10.1016/0167-9457(88)90012-7

Soong, G. P., Lovie-Kitchin, J. E., & Brown, B. (2001). Does mobility performance of visually impaired adults improve immediately after orientation and mobility training? Optometry & Vision Science, 78(9), 657-666.

Thurman, D. (1983). Career Education and Teacher Attitudes. Education of the Visually Handicapped, 14(4), 133-39.

Tigges, S. (2004). Slaying dragons: Building self-confidence and raising expectations through orientation center training. American Rehabilitation, 28(1), 30-39. Retrieved from https://www2.ed.gov/news/newsletters/amrehab/2004/autumn/full.pdf.

Tisdell, E. J. (2007). In the new millennium: The role of spirituality and the cultural imagination in dealing with diversity and equity in the higher education classroom. Teachers College Record, 109(3), 531–560.

Turvey, M. T., Burton, G., Pagano, C. C., Solomon, H. Y., & Runeson, S. (1992). Role of the inertia tensor in perceiving object orientation by dynamic touch. Journal of Experimental Psychology: Human Perception and Performance, 18(3), 714-727. Retrieved from http://www.haskins.yale.edu/Reprints/HL0875.pdf.

Ubel, P. A., Loewenstein, G., & Jepson, C. (2005). Disability and sunshine: can hedonic predictions be improved by drawing attention to focusing illusions or emotional adaptation? Journal of Experimental Psychology: Applied, 11(2), 111. Retrieved from https://www.andrew.cmu.edu/user/gl20/GeorgeLoewenstein/Papers_files/pdf/DisabilitySunshine.pdf.

Uslan, M., & Schriebman, K. (1980). Drop-off detection in the touch technique. Journal of Visual Impairment & Blindness, 74(5), 179–182.

Van Boven, R. W., Hamilton, R. H., Kauffman, T., Keenan, J. P., & Pascual-Leone, A. (2000). Tactile spatial resolution in blind Braille readers. Neurology, 54(12), 2230–2236.

Willoughby, D., & Monthei, S. L. (1998). Modular instruction for independent travel for students who are blind or visually impaired: Preschool through high school. Baltimore, Maryland: National Federation of the Blind.


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