Future Reflections                                                   Special Issue: Low Vision and Blindness 2005

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The Problems with Vision Stimulation

Editor’s Note: In a 1996 issue of the Journal of Visual Impairment and Blindness (vol. 90, no. 5, Sept-Oct, 1996), researchers and professors Kay Ferrell, Ph.D., and D. William Muir, M.A., raised questions about the efficacy of teaching visual perceptual skills in a piece entitled, “A Call to End Vision Stimulation Training.” In it, they state: “The cautions against using vision stimulation are significant. The main ones are 1) the research to support visual skills training is ambiguous at best; 2) the procedures violate the principle of normalization and diminish the self-esteem of children, families, and teachers; and 3) the training consumes time better devoted to instruction for real-life demands.” Unfortunately, many programs and educators have chosen to ignore these cautions and continue to practice and promote vision stimulation training. In the excerpt below from the Handbook for Itinerant and Resource Teachers for the Blind and Visually Impaired, published by the National Federation of the Blind, co-author Doris Willoughby discusses in more detail the problems of vision stimulation:

The Young Child’s Development
All the senses of infants and preschool children, along with other physical and mental abilities, are in the process of development. It may be hard to know just how much potential exists for a particular faculty such as vision or hearing. In addition to the maturation of the faculty in question, one must also consider the child’s ability to communicate. For example, a very young child cannot answer a sophisticated question such as “Which lens gives a better focus?” even if the meaning is carefully explained. He/she may not even answer apparently simple questions accurately, due to fear, misunderstanding, a desire to please, etc. Tests using letters are impossible for children who cannot read; even the “E” chart is unreliable with very immature children.

Parents will naturally ask their children questions about what they see, in words they can understand. Parents will naturally teach children to recognize colors, to name the things they see in daily life, etc. Up to a point, it makes sense to say, “If they don’t try to use their sight, no one will know how much vision they have.”

Stretching to the Breaking Point
Unfortunately, a strong system of beliefs has grown up among many eye doctors (chiefly optometrists)--a system of beliefs which stretches the idea of “vision development” far beyond good sense.

Equipment, exercises, and workbooks (by Dr. Natalie Barraga and others) are promoted as “stimulating” or “developing” vision. They are promoted for older children as well as for preschoolers.

Advocates say these programs help students to make better use of existing vision. Promoters seem to imply, also, that vision will actually improve, although they avoid actually making that statement.

However, the authors of this Handbook, together with the National Federation of the Blind, are convinced that “vision stimulation” programs (as carried out by educators of the visually impaired) do not improve vision or the use of vision to any significant degree. Furthermore, overemphasis on such efforts actually does harm in a number of ways.

The appropriate thing for a teacher to do is to explore, for practical reasons, the question of how well a child can actually see. Then the teacher should proceed to teach the child efficient techniques.

False Hopes
Parents of blind children, like parents of children with other disabilities, usually find it very hard to accept the fact of the disability. They tend to consult one professional person after another, seeking someone who will tell them what they want to hear: “No, your child is not disabled.” Parents, therefore, are extremely vulnerable to a promoter of “vision stimulation.” False hopes are easily raised. Inappropriate expectations are easily encouraged. Development of a positive philosophy on a solid basis (including the realization that alternative techniques can be very effective) is easily destroyed.

Inappropriate Expectations
Despite occasional remarks to the contrary, advocates of “vision stimulation” raise inappropriate expectations.

When the print-reading student who struggles with headaches, slow speed, and fatigue is given “vision stimulation” workbooks--then the viable alternative of Braille is forgotten. When a child whose eyelashes brush the page is pushed to discern huge capital letters--then the idea of reading print on a regular basis springs up. When a child walks hesitantly forward and is prodded to guess, “is that a tree?”--then the idea of traveling without a cane is solidified.

Poor Techniques Encouraged, Effective Methods Ignored

“Vision stimulation” programs encourage codified guessing. Typically, a few simple shapes are used and the child strains to distinguish among them--often despite the fact that she cannot see enough detail to recognize a given shape reliably. Print “reading” is applauded even when letters cannot be seen clearly, and even when only part of a word can be seen. All of this takes time which could have been used in learning to read Braille quickly, comfortably, and reliably.

“Vision stimulation” exercises for mobility teach students to guess about their environment. Examples include:
· Slowing down for shadows on the sidewalk
· Noticing blobs of light and estimating them to be doorways, windows, etc.
· Trying to see part of the traffic light if one cannot see all of it
· Watching for jagged lines which may indicate steps
· Assuming that if the head of the person in front goes down, there is probably a stairway going down

Children and adults with low vision usually figure out approaches such as these on their own. They are unreliable and unsafe methods. For an educator or an eye doctor to encourage and codify such things is unconscionable. Such approaches encourage slow and unsafe travel, and discourage effective travel with a cane.

Misleading, Emotional Phrases

“The child (about five years old) walked up the steps unaided. He had never walked up steps outdoors alone before.”

This remark was part of a talk promoting “vision stimulation.”

Consumer education, sociology courses, etc., teach citizens to analyze statements made by merchants and politicians. The educated consumer is alert for propaganda, which may be defined as one-sided communication designed to discourage analysis. However, most consumers have little familiarity with the choices available in regard to techniques for the blind, and are not likely to analyze, as they should. Popular myth holds that the use of vision is always best, however inefficient

Consider a careful analysis of the remark about the child on the steps:

How do we know that “vision stimulation” is the cause for his walking upstairs alone for the first time? Other possibilities reasons include: his parents stopped being afraid; the child stopped being afraid; he was urged and expected to do it; he had reached an appropriate maturity level (note that we do not know if he has additional disabilities); etc. It is quite possible that he does not see any better than before, and does not use his vision any better, but is succeeding because of other factors.

A child of five could have learned long ago to go up and down steps safely by using a cane (or, for that matter, without one, by using other tactual techniques). Yet the speaker clearly implied that the reason this child had not done so is because he had not had “vision stimulation.” It is much more likely that he simply has not been allowed to go alone before.

Since the child has very little vision, he probably does not see the steps well. He may simply be holding the rail and proceeding tactually. Or, he may be using some of the visual guessing discussed above. In any event, climbing these particular steps does not necessarily mean that he can easily and safely go up and down steps everywhere by use of his vision.

Following are some other examples of emotional, slanted remarks often used in promoting “vision stimulation.” Each is followed by a comment (in brackets) by the authors of this Handbook.

“See how this child goes around things without a cane!” (Seeing some things visually does not prove that a cane is not desirable for efficient, speedy travel.)

“We will help him interpret a blurry world.” (Blurry vision does not need to mean “a blurry world,” if proper techniques are used so that one need not rely on vision.)

“He has greater independence and a better self-image by using vision.” (The self-image of a person trying to rely on inadequate vision is indeed poor. But it cannot be raised to normal levels by trying to compete on an unequal basis. Independence and self-image can be improved only by recognizing that it is respectable to be blind, and that using alternative techniques--which do not require vision--can enable a person to compete on an equal basis. Urging a person to “improve” the use of inadequate vision is a way to lower self-esteem, because he realizes he cannot possibly “do better.”)

“Now this boy is walking unaided.” (Unfortunately, this expression is often used to mean that a person has no cane. In contrast, we should regard the cane as one way of walking “unaided”--that is, without the assistance of another person. It is a better way than the use of inadequate vision. Here is an interesting comparison: A carpenter would not say proudly, “I did this job unaided--I didn’t use any of my tool!”)

“She is losing vision. It is important for her to have “vision stimulation” to build up her visual memory.” (A person losing vision should spend her time learning methods which will continue to work. There are other ways to learn besides through vision; one need not have a “visual memory” of something in order to understand it.)

What Really Works?
If a visually impaired person really has enough visual potential to perform up to his/her general ability by using vision alone, then this will be demonstrated in the context of regular daily life. If regular medical attention (including corrective lenses) and the experiences of daily life demonstrate that the student cannot comfortably and reliably do things as well as others do them, then alternative techniques (not requiring the use of vision) should be taught. The student will then be able to rely on vision if and when it is really best for a given situation, and use other methods when vision is not efficient.

Reprinted from the Handbook for Itinerant and Resource Teachers of Blind and Visually Impaired Students, by Doris M. Willoughby and Sharon L. M. Duffy. Available from the National Federation of the Blind, (410) 659-9314, <www.nfb.org>.

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