American Foundation For The Blind Research Articles

Genealogy, the study of family trees, has always been an exciting discovery process. Today, the internet provides fingertip tools for digging deep into our families' lineages and origins to find our inherited roots and branches.Learning about past generations of relatives and their geographical origins helps us better understand ourselves. It also allows us to populate our unique family trees that illustrate how our ancestral families merged and blended. We can take delight in discovering that we are the proud “acorns that have descended from our grandparents' sturdy oaks” (David Everett, 1795) or perhaps that we are “chips off the old block.”Professional organizations can likewise benefit from understanding their association's history. There is value in understanding our professional family relatives who preceded us, and discovering how particular benefits and services came about and how they have evolved assists us as we move forward.In The Tempest, Shakespeare wrote, “What's past is prologue.” This phrase, engraved on the National Archives Building in Washington, DC, emphasizes that the past foreshadows and portends the future. The past is a valuable guide going forward. It assists us in anticipating what is in store for us by focusing on what has preceded it. Said another way, what happened first determines what comes later. The past literally sets the stage and provides context for the next act.Associations by nature are future oriented and progress focused. Well-developed strategic plans are critical tools that ensure growth and quality improvements. Equally important is sharply focused attention on and respect for knowing and understanding the association's back story. A strategic plan that is developed and built on an association's historical foundation is on much more solid ground than if it were not. As the Association for Education and Rehabilitation of the Blind and Visually Impaired (AER) evolves into the future, there is value in safeguarding and periodically revisiting our association's family tree and its journey to today.Many of our members, now retired or soon-to-be retired, joined AER when it was first established in 1984. These inaugural AER members “transferred” from two predecessor grandparent organizations—Association for Education of the Visually Handicapped (AEVH) and American Association of Workers for the Blind (AAWB). AEVH had originally been known as the American Association of Instructors of the Blind, whereas AAWB's ancestral roots came from The American Blind People's Higher Education and General Improvement Association (Hardy & Cull, 1972).In the early 1980s, leaders of both associations recognized that these two separate organizations had more commonalities than differences. Although AAWB's focus was adult rehabilitation and AEVH's focus was school-age education, leaders from both organizations discussed consolidating the two organizations. Doing so would reduce central office duplication, and, most important, bridge the transition gap between education and rehabilitation when high school graduates need career-oriented, world-of-work rehabilitation services. The boards of these parent organizations made plans and compromises to consolidate the two associations into a new organization. They temporarily referred to this offspring as “The Alliance.”A merger of two families, and similarly in the case of two professional organizations, requires many decisions. One typical discussion item is what to do with duplicate belongings. Families realize that, going forward, they do not need two kitchen tables, two pianos, two extension ladders; in the same situation, our two parent professional organizations realized that, among other things, two boards of directors, two sets of officers, and two central offices were redundant and unnecessary.As talks considering a consolidation of the two organizations progressed, the fate of AEVH's respected journal, Education of the Visually Handicapped (EVH), became a serious pivotal point of discussion and a potential deal breaker (R. L. Welsh, personal communication, 1984). The AAWB did not have a professional peer-reviewed journal parallel to EVH, but it did have AAWB Reports, an annual publication that primarily documented the association's business. During negotiations, AEVH leaders “dug in their heels” and adamantly insisted that, as the consolidation went forward, EVH would continue as a stipulated benefit of membership.I credit the AEVH leadership back in the early 1980s for taking a strong stand to preserve AEVH's journal. They recognized the value of encouraging and championing our field's body of knowledge by publishing peer-reviewed professional research and practice articles. They saw that this focus on our field's professional literature was a key mission-essential duty of a professional organization, and they stood by their commitment to it.EVH's mission was never to compete with the American Foundation for the Blind's (AFB) New Outlook for the Blind, later renamed the Journal of Visual Impairment and Blindness (JVIB). EVH's intent was to provide authors and practitioners another option for publication focused on the development and education of school-aged students. The leaders of the new association formally adopted EVH into the new Alliance family.Dr. Richard “Rick” Welsh, who spearheaded the consolidation of the two organizations and became AER's first president, realized the importance of this issue and approached me about becoming involved in EVH going forward. Dr. Welsh, the visionary and big-picture leader of leaders, made a pitch that was impossible for me to refuse. He pointed out that the stakes were so high that, without EVH's future being guaranteed, the necessary and valued consolidation of the two organizations likely might not result. I agreed to join Dr. LaRhea Sanford and Dr. Rosanne Silberman as an EVH executive editor. I remember well Dr. Welsh emphasizing that my tenure would be for no more than 2 years. In this case, Dr. Welsh, who was typically always accurate in his assessments, was not! My tenure lasted more than 17 years.At the time, EVH was experiencing many challenges, chief among them was a critical shortage of quality submissions for publication. A plan was developed to literally keep the ship afloat and, after that, to move the journal ahead, allowing it to gain speed and return to a credible vessel. In response, we initiated a major effort to encourage direct-service providers to share their effective practice successes.With the consolidation of AAWB and AEVH, the scope of EVH naturally expanded despite the artificial limit indicated by its name. As Kathy Megivern wrote in the final issue of EVH, “The scope of Education of the Visually Handicapped (EVH) has been slowly expanding to include articles on rehabilitation as well as education.” It was apparent that the name “EVH” no longer fit the journal.As in families, when a newborn arrives, a name is given the newly welcomed offspring. At that point, The Alliance needed two new names—one for the new association and one for the journal. Following a contest to come up with a name for the new association, Dr. Bill Bryan's submission of “The Association for Education and Rehabilitation of the Blind and Visually Impaired (AER)” was selected.Correspondingly, EVH needed a new name as well because it referenced “education,” but not “rehabilitation” in the title. After discussions that I had with Kathy Megivern, AER's first executive director, the new title RE:view was offered as a proposal to the AER board for approval and was accepted.The new journal, RE:view, was introduced with its first issue in the spring of 1989. To answer Shakespeare's question in Romeo and Juliet, “What's in a name?” RE:view was based on an acronym—the “R” for rehabilitation and the “E” for education. Following the colon, “view” was designed to imply “perspective” and as a bit of a play on the visual component of our field. Coincidently, the first two letters of the word “view” could be thought to stand for “visual impairment.”RE:view was published quarterly, beginning with the first volume in 1989 and continued so for the next 19 years. In the early 1990s, Mary Nelle McLennan joined the team as an executive editor and developed “Springboard,” a regularly appearing column as a forum that featured creative practice articles. Her practitioner-authored feature appeared quarterly for 16 years, lasting until RE:view was discontinued in 2008.It is important to note that EVH, and later, RE:view, were published by Heldref Publications, a Washington, DC, nonprofit publisher of educational journals and magazines. Both journals were a benefit of association membership; a team of members of AEVH and later of AER served as executive editors and were responsible for the content. Heldref managed the full publication and provided a part-time managing editor. In 2008, AER severed the relationship with Heldref, which in the past had worked extremely well and was a major benefit to our association. That same year, AER discontinued RE:view.In the fall of 2019, I was contacted by Mary Nelle McLennan and Dr. Bill Wiener who represented a small group of concerned AER members who were investigating the creation of a new practitioner-focused journal. They invited me to join their effort to establish a journal that would follow in the footsteps of RE:view but would also extend new and dynamic facets to AER members as AER's professional journal. I declined their invitation as I felt that newer blood would bring more value than my own, but I supported the effort with my full blessing. For 3 years, that development team has continued its exhaustive work to create a new, timely, online descendent of RE:view, and now The New RE:view (TNR) is a reality.I am delighted that this decision was made to “build back better” what I will call a treasured “golden oldy.” Things from the past, although old, need not become dust-covered, irrelevant relics. Rather, treasured family and association antiques can provide current and future value as they are refreshed and rejuvenated. AER continues to need a journal that supports practitioners in the field by adding to our professional literature and body of knowledge.I salute AER's efforts to reinstitute a “new RE:view.” I raise my glass in a toast to TNR's future success. I have no doubt that it will succeed and will fill a need for our profession. It is in good hands of able editors. It is in the good hands of our AER members. Truly, RE:view was and The New RE:view will be a journal of, for, and by the members of AER.The past is positively prologue. RE:view was successful in the past, and it therefore portends that TNR will be so in the future.

In Support of the Evidence Base Since 1921: The American Foundation for the Blind and the <i>Journal of Visual Impairment & Blindness</i>

Audiobooks are one of the many mediums for the delivery of literary works in the digital age. However, audiobooks have existed since 1931. For example, the American Foundation for the Blind and the Library of Congress would provide audiobook-based programmes for the visually impaired. The use of this particular medium in Malay literature is still not considered widespread. After that, audiobooks started to flourish in the field of early childhood education and currently, there is a publishing company that produces audiobooks in Malaysia. However, its existence and evolution in literature are not widely known than to literary works delivered through other new media. This study, funded by the faculty grant GPF006K-2018, examined the various forms of literary audiobooks published by the company Nusantara as a means to provide alternative reading material in Malaysia. This study aimed to identify and discuss the history and development of literary audiobooks in Malaysia to highlight their form and importance in the digital era. This study utilised text analysis to examine past research on audiobooks and analysed various literary audiobooks available in the market. Additionally, interviews were conducted with different publishers to get their feedback regarding the general acceptance of such material amongst their customers. Findings showed that Nusantara Audiobooks actively publishes literary audiobooks, be it from Malaysia or Indonesia. In conclusion, these digital materials in the market would diversify reading methods and analyse literary works. Keywords: audiobooks, Malay literature, digital, alternative, evolution

This study explored the potential of three-dimensional printing (3DP) technology in producing a three-dimensional (3D) medication label for blind and visually impaired (BVI) patients to ease their drug administration. Different variations of label wordings, dosing instructions, and medication identifiers were designed with reference to guidelines by the American Foundation for the Blind. Shapes and symbols were used as dosing instructions and medication identifiers to the patient’s medical conditions. Prototype designs were created with common graphics computer-assisted drafting software and 3D-printed using acrylonitrile butadiene styrene as the polymer filament. Feedback was then obtained from five people with normal vision and four BVI persons. The initial prototype comprised four components, namely, medication name and strength, patient’s name, dosing instruction, and medication identifier. A revised label comprising the latter two components was developed after feedback by BVI persons. Words were in all uppercase and regular font type, with a 5-mm center-to-center letter spacing. Elevation heights of the letters alternated between 1 mm and 1.5 mm. A half sphere represented the medication dose unit, while vertical lines and a horizontal center line with alternating elevation of arrowheads represented the frequency of administration and the medication’s consumption in relation to food, respectively. Symbols based on target organs were used as medication identifiers. With rapid advancements in 3DP technologies, there is tremendous potential for producing 3D labels in patients’ medication management.

Editor’s Note: This commentary is based on the conference sessions, “Preparing Teachers to Work with Students with CVI: The University Perspective,” by Laura Bozeman, Mindy Ely, Kathryn Botsford, and Yue-Ting Siu; and “Mentoring Doctoral and Other Students to Contribute Critical Research to JVIB,” facilitated by Sandra Lewis, Rona Pogrund, and Rebecca Burrichter, which took place Thursday, February 28, 2019, and Friday, March 1, 2019, respectively, at the American Foundation for the Blind (AFB) Leadership Conference in Arlington, VA.

Almost two decades ago, the following information on the development of a national agenda on vision and aging was published in the From the Field section of the Journal of Visual Impairment & Blindness (JVIB): ... the American Foundation for the Blind (AFB) and the National Aging and Vision Network have launched the development of a national agenda on vision and aging. The concept of a national agenda began with a survey that AFB's National Aging Program team sent to National Aging and Vision Network members in December 1997.... [A]t the March 1998 Josephine L. Taylor Leadership Institute, aging work-group participants, comprised of professionals and consumers, worked on identifying critical issues for the agenda to address (National Agenda on Vision and Aging, 1998, p. 850). The issues identified at the conference became a list of goals, which had the intended purpose of shaping public policies and attitudes in order to ensure the full participation in society of individuals aged 55 years and older. The goals of the agenda were: * develop a self-advocacy skills training curriculum for inclusion in vision rehabilitation programs serving older persons who are visually impaired; * increase public awareness about age-related vision loss and vision-related services; * carry out advocacy efforts to increase federal funding for the Title VII, Chapter 2 Program of the Rehabilitation Act (Independent Living Services for Older Individuals Who Are Blind [OIB]); * increase the supply of qualified personnel providing vision rehabilitation services to older individuals who are visually impaired; * expand access to employment opportunities for older persons with visual impairments; and * promote the coordination of data collection and outcome measurement efforts, which support the targeted goals of increased consumer self-advocacy, greater public awareness of vision rehabilitation services, sufficient funding for services, increased supply of qualified personnel, and expanded access to information and community resources. OUTCOMES OF THE FIRST NATIONAL AGENDA ON VISION AND AGING By 2005, the National Aging and Vision Network (formed by AFB) accomplished two objectives from the third goal of the agenda on vision and aging (Orr, Scott, & Rogers, 2005): * achieve the $13 million threshold established by Congress in the Rehabilitation Act as the trigger level for Chapter 2 formula funding to ensure that each state receives a minimum level of funding; and * achieve a funding level of at least $26 million for the Title VII, Chapter 2 program, a funding level established by state agency directors as the base amount needed to establish a nationwide service delivery program. These achievements established a framework to fund a nationwide service delivery program, ensuring money for every state to provide OIB services. Although the Aging and Vision Network worked diligently toward its goal, since 2005, no united effort has been sustained. Thus, it is time to renew the call to action to meet the needs of millions of aging baby boomers who are losing vision at a time when national, state, and local resources are stretched and overwhelmed. With the exception of stimulus funding, the OIB program has received approximately the same amount of funding annually, and the numbers of individuals being served by this program appear to be declining. During fiscal year 2005, 63,766 individuals were served with a federal allocation of $33,227,040 (U.S. Department of Education, 2009). According to the Rehabilitation Services Administration's 2012 report, only 67,273 individuals nationwide benefited from independent living services provided through this program (U.S. Department of Education, 2014). The latest published reports (2013) indicate that 59,133 received services (U.S. Department of Education, 2016). …

iOS in the Classroom: A Guide for Teaching Students with Visual Impairments, Larry L. Lewis, Jr. New York: AFB Press, 2016,138 pp. Paperback, $29.95; e-book (ePUB or Kindle), $20.95; online, $17.95. It is wonderful to have been given the opportunity to review iOS in the Classroom: A Guide for Teaching Students with Visual Impairments, by Larry L. Lewis, Jr. A growing need exists for useful information related to best practices for instruction using current technology for students who are visually impaired (that is, those who are blind or have low vision), and this publication could not be more timely or responsive to this persistent demand. A NEW RESOURCE TO SUPPORT MORE EXTENSIVE ASSISTIVE TECHNOLOGY TRAINING On May 1, 2016, the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) launched the Certified Assistive Technology Instructional Specialist for People with Visual Impairments (CATIS) credential. The CATIS certification has created a national standard in the area of assistive technology instruction for people who are visually impaired in the United States. iOS in the Classroom: A Guide for Teaching Students with Visual Impairments is a brand-new resource that can support the training, experience, and coursework required of the CATIS credential, as well as the diverse learning needs of people with visual impairments. The guidebook features Larry Lewis's succinct method of communicating about innovative technological solutions for people who are visually impaired, and it will benefit a wide range of professionals who work in the field of visual impairment. The guide provides vital information about the accessibility of iOS--an operating system designed to be used with mobile devices manufactured by Apple such as the iPad, iPhone, and iPod--and provides instructional strategies for people with visual impairments who use these devices in classroom settings and elsewhere. It is common for vision professionals to be on the lookout for additional sources of up-to-date professional development opportunities related to iOS technology. I suggest such individuals consider pairing this guide together with the American Foundation for the Blind (AFB) eLearning webinar, iOS in the Classroom: iPad Learning Success for Students with Vision Loss. Also created by Larry Lewis, this webinar is the perfect complement to this new publication. SUITABLE FOR A BROAD AUDIENCE The book is intended to serve as a guide for instructors of students with visual impairments whose students would benefit from using iPads in educational contexts. The descriptions provided within this book are written for an iPad running iOS version 9. The strategy of targeting a specific iOS device, iOS version, and audience facilitates a high degree of consistency within the guide. This approach makes the content very easy to follow from chapter to chapter. Thus, this book is an essential tool for vision professionals. The information presented throughout the book is applicable in settings outside of the classroom, and it includes an appendix, entitled Beyond the Classroom, that specifically describes how an iOS device can be used at home (for identifying colors) or in the community (for identifying paper currency or wayfinding). The Resources section also includes information that is suitable for a broad audience. Vision professionals who are providing instruction in the use of any iOS device will find information within this publication for an extensive number of tasks, relevant instructional strategies, and important resources. The reader can adapt the content of the book for any setting (for transition services or vision rehabilitation programs, for example) and any iOS device (that is, iPad, iPhone, or iPod). …

Visual decline is one of the most prominent features of age-related disability among older adults. In 2012, more than 20.6 million American adults reported vision loss (Blackwell, Lucas, & Clarke, 2012), and worldwide, according to the World Health Organization (2014), more than 285 million people are estimated to have visual impairment. Individuals with visual impairments are affected by significant psychosocial stressors, functional limitations, and increased mortality (Kempen, Ballemans, Ranchor, van Rens, & Zijlstra, 2012). Studies have shown that older individuals with visual impairments have diminished ability to perform activities of daily living (Knudtson, Klein, Klein, Cruickshanks, & Lee, 2005), and demonstrate poor health and increased disability (Crews, Chou, Zhang, Zack, & Saaddine, 2014). Furthermore, individuals with vision loss are often socially isolated (Alma et al., 2011), and have increased levels of psychological distress, anxiety, and depression (Kempen et al., 2012; Rovner, Zisselman, & Shmuely-Dulitzki, 1996). Although studies have shown a relationship between vision loss and depression, Rovner et al. (2014) demonstrated that the combination of mental health treatments and low vision interventions halved the incidence of depressive disorders relative to standard low vision interventions alone in individuals with macular degeneration. Furthermore, there is a correlation between visual impairment and increased mortality (Jacobs, Hammerman-Rozenberg, Maaravi, Cohen, & Stessman, 2005; Christ, Lee, Lam, Zheng, & Arheart, 2008; McCarty, Nanjan, & Taylor, 2001; Cacciatore et al., 2004). Compared to individuals with hearing deficits, individuals with vision loss have higher morbidity and are more likely to suffer from diabetes mellitus, heart disease, and hypertension (Crews & Campbell, 2004; Crews, Jones, & Kim, 2006). Notably, an association has been identified between visual impairment and an increased risk of hospitalization, which is likely secondary to the reduced functional ability associated with visual impairment and other comorbidity (Evans, Smeeth, & Fletcher, 2008). It is noteworthy that reading prescription labels and self-administering the correct drug and dosage at correct intervals requires a level of vision that most individuals with visual disabilities are incapable of, even with appropriate optical or auxiliary aids. Studies have suggested that medication mismanagement may be related to vision loss (American Foundation for the Blind, 2008; Murray, Darnell, Weinberger, & Martz, 1986; Smith & Bailey, 2014). The American Foundation for the Blind in 2008 reported that individuals with visual impairments lack access to critical medication use instructions. Common negative consequences of visual impairment include not taking medications at proper dosages or mistakenly taking expired or incorrect medications (American Foundation for the Blind, 2008; Smith & Bailey, 2014). As shown previously, difficulty with medication adherence can cause detrimental health consequences (McCann et al., 2012; Gellad, Grenard, & Marcum, 2011; Hughes, 2004). Prior studies have noted that individuals with visual impairments are more than twice as likely to need help managing their medication compared to individuals with typical vision (McCann et al., 2012). Therefore, it is important to minimize barriers that impair proper adherence to medication regimens. [FIGURE 1 OMITTED] One medication-use device that is widely employed within the Department of Veterans Affairs is ScripTalk, created by Envision America (2014), an audible prescription reader that uses radio-frequency identification and text-to-speech technology to speak the prescription label to the user (Figure 1). The ScripTalk computer software can be used by a pharmacy to encode a microchip located in the prescription label with pertinent information, including the medication's name, proper dosage, side effects, warnings, and pharmacy name and telephone number. …

Section 508 of the Rehabilitations Act of 1973 states that federal agencies are required to maintain accessible web-based information for persons with disabilities, namely, visual impairments. Studies spanning over 1 decade conducted by The American Foundation for the Blind and Towson University’s Universal Usability Lab investigated federal home pages for Section 508 violations. Both studies concluded that numerous university, corporate, federal, and federal contractor websites are largely inaccessible to people with disabilities—specifically in terms of clarity, consistency, and fidelity to standards. Due to inconsistencies across federal agencies, constant website updates, and webmaster turnaround, there is a need for practical guidelines for web page design compliant with Section 508, the Americans with Disabilities Act, and the World Wide Web Consortium’s Web Content Accessibility Guidelines, with particular focus on the visually impaired.

For many years, increasing caseloads for vision professionals have caused concerns about the impact on educational services. Average caseload sizes the literature have remained fairly consistent across decades, with 19.5 students per professional the 1980s (Pelton, 1986), 18 students the 1990s (Griffin-Shirley, McGregor, and Jacobson, 1999), and 22 students the 2000s (Griffin-Shirley et al., 2004). In contrast, the optimal caseload for vision professionals has been approximated as eight students (Mason & Davidson, 2000). Discrepancy between ideal and actual caseload sizes may partly be due to how service levels are determined. Lack of consistency determining the appropriate level of service for a given child can lead to inflated caseload sizes and ineffective services. Goal 4 of the National Agenda for the Education of Children and Youths with Visual Impairments, Including Those with Multiple Disabilities noted that caseloads are based on the assessed needs of students (American Foundation for the Blind, 2003). An example of such a rubric for determining service delivery levels was developed by the Atlantic Provinces Special Education Authority (see, for example, MacCuspie, 1998). In 1995, the Michigan Department of Education's Low Incidence Outreach office began adapting a model developed Montgomery County, Pennsylvania, that used student and environmental characteristics to determine service delivery levels. The task force that was created to adapt the model developed a set of in house severity rating scales to determine optimal vision service levels. The scales were revised 2008 based on feedback from surveys of Michigan vision professionals and with input from professionals across the United States. The scales are now popular enough that national surveys of how the scales are being used seemed appropriate. Interest the scales is shown by links to them on such vision-related websites as that of the Texas School for the Blind and Visually Impaired, ; the Association for Education and Rehabilitation of the Blind and Visually Impaired, ; Maryland-based orientation and mobility (OM and Paths to Literacy for Students Who Are Blind or Visually Impaired, . The scales are available online at the Low Incidence Outreach website: . The current study reports on the responses from a cross section of OM the Orientation and Mobility Severity Rating Scale Plus (OMSRS +), which is for use with children with multiple disabilities; the Vision Services Severity Rating Scale (VSSRS); and the Vision Services Severity Rating Scale Plus (VSSRS +), which is for use with children with multiple disabilities. MATERIALS AND METHODS Two surveys, one with the O&M scales and one with the Vision Services scales, were distributed to achieve a representation of both O&M specialists and teachers of children with visual impairments. Potential participants were notified about the online surveys through announcements and flyers distributed at the 2012 conference of the Michigan Chapter (MAER) of the Association for Education and Rehabilitation of the Blind and Visually Impaired (AER) and postings on vision professional electronic discussion groups (MAER, O&M, AER). After a brief explanation of the intent of the surveys, professionals were asked to visit either or both surveys and ill them out online. …

IntroductionSupermarkets are functionally challenging environments for people with vision impairments. A supermarket is likely to house an average of 45,000 products in a median floor-space of 4,529 square meters and many visually impaired people are unable to shop without assistance, which greatly impedes personal independence (Nicholson et al.). The task of selecting goods in a supermarket is an “activity that is expressive of agency, identity and creativity” (Sutherland) from which many vision-impaired persons are excluded. In response to this, a number of proof of concept (demonstrating feasibility) and prototype assistive technologies are being developed which aim to use smart phones as potential sensorial aides for vision impaired persons. In this paper, I discuss two such prototypic technologies, Shop Talk and BlindShopping. I engage with this issue’s list theme by suggesting that, on the one hand, list making is a uniquely human activity that demonstrates our need for order, reliance on memory, reveals our idiosyncrasies, and provides insights into our private lives (Keaggy 12). On the other hand, lists feature in the creation of spatial inventories that represent physical environments (Perec 3-4, 9-10). The use of lists in the architecture of assistive technologies for shopping illuminates the interaction between these two modalities of list use where items contained in a list are not only textual but also cartographic elements that link the material and immaterial in space and time (Haber 63). I argue that despite the emancipatory potential of assistive shopping technologies, their efficacy in practical situations is highly dependent on the extent to which they can integrate a number of lists to produce representations of space that are meaningful for vision impaired users. I suggest that the extent to which these prototypes may translate to becoming commercially viable, widely adopted technologies is heavily reliant upon commercial and institutional infrastructures, data sources, and regulation. Thus, their design, manufacture and adoption-potential are shaped by the extent to which certain data inventories are accessible and made interoperable. To overcome such constraints, it is important to better understand the “spatial syntax” associated with the shopping task for a vision impaired person; that is, the connected ordering of real and virtual spatial elements that result in a supermarket as a knowable space within which an assisted “spatial practice” of shopping can occur (Kellerman 148, Lefebvre 16).In what follows, I use the concept of lists to discuss the production of supermarket-space in relation to the enabling and disabling potentials of assistive technologies. First, I discuss mobile digital technologies relative to disability and impairment and describe how the shopping task produces a disabling spatial practice. Second, I present a case study showing how assistive technologies function in aiding vision impaired users in completing the task of supermarket shopping. Third, I discuss various factors that may inhibit the liberating potential of technology assisted shopping by vision-impaired people. Addressing Shopping as a Disabling Spatial Practice Consider how a shopping list might inform one’s experience of supermarket space. The way shopping lists are written demonstrate the variability in the logic that governs list writing. As Bill Keaggy demonstrates in his found shopping list Web project and subsequent book, Milk, Eggs, Vodka, a shopping list may be written on a variety of materials, be arranged in a number of orientations, and the writer may use differing textual attributes, such as size or underlining to show emphasis. The writer may use longhand, abbreviate, write neatly, scribble, and use an array of alternate spelling and naming conventions. For example, items may be listed based on knowledge of the location of products, they may be arranged on a list as a result of an inventory of a pantry or fridge, or they may be copied in the order they appear in a recipe. Whilst shopping, some may follow strictly the order of their list, crossing back and forth between aisles. Some may work through their list item-by-item, perhaps forward scanning to achieve greater economies of time and space. As a person shops, their memory may be stimulated by visual cues reminding them of products they need that may not be included on their list. For the vision impaired, this task is near impossible to complete without the assistance of a relative, friend, agency volunteer, or store employee. Such forms of assistance are often unsatisfactory, as delays may be caused due to the unavailability of an assistant, or the assistant having limited literacy, knowledge, or patience to adequately meet the shopper’s needs. Home delivery services, though readily available, impede personal independence (Nicholson et al.). Katie Ellis and Mike Kent argue that “an impairment becomes a disability due to the impact of prevailing ableist social structures” (3). It can be said, then, that supermarkets function as a disability producing space for the vision impaired shopper. For the vision impaired, a supermarket is a “hegemonic modern visual infrastructure” where, for example, merchandisers may reposition items regularly to induce customers to explore areas of the shop that they wouldn’t usually, a move which adds to the difficulty faced by those customers with impaired vision who work on the assumption that items remain as they usually are (Schillmeier 161).In addressing this issue, much emphasis has been placed on the potential of mobile communications technologies in affording vision impaired users greater mobility and flexibility (Jolley 27). However, as Gerard Goggin argues, the adoption of mobile communication technologies has not necessarily “gone hand in hand with new personal and collective possibilities” given the limited access to standard features, even if the device is text-to-speech enabled (98). Issues with Digital Rights Management (DRM) limit the way a device accesses and reproduces information, and confusion over whether audio rights are needed to convert text-to-speech, impede the accessibility of mobile communications technologies for vision impaired users (Ellis and Kent 136). Accessibility and functionality issues like these arise out of the needs, desires, and expectations of the visually impaired as a user group being considered as an afterthought as opposed to a significant factor in the early phases of design and prototyping (Goggin 89). Thus, the development of assistive technologies for the vision impaired has been left to third parties who must adopt their solutions to fit within certain technical parameters. It is valuable to consider what is involved in the task of shopping in order to appreciate the considerations that must be made in the design of shopping intended assistive technologies. Shopping generally consists of five sub-tasks: travelling to the store; finding items in-store; paying for and bagging items at the register; exiting the store and getting home; and, the often overlooked task of putting items away once at home. In this process supermarkets exhibit a “trichotomous spatial ontology” consisting of locomotor space that a shopper moves around the store, haptic space in the immediate vicinity of the shopper, and search space where individual products are located (Nicholson et al.). In completing these tasks, a shopper will constantly be moving through and switching between all three of these spaces. In the next section I examine how assistive technologies function in producing supermarkets as both enabling and disabling spaces for the vision impaired. Assistive Technologies for Vision Impaired ShoppersJason Farman (43) and Adriana de Douza e Silva both argue that in many ways spaces have always acted as information interfaces where data of all types can reside. Global Positioning System (GPS), Radio Frequency Identification (RFID), and Quick Response (QR) codes all allow for practically every spatial encounter to be an encounter with information. Site-specific and location-aware technologies address the desire for meaningful representations of space for use in everyday situations by the vision impaired. Further, the possibility of an “always-on” connection to spatial information via a mobile phone with WiFi or 3G connections transforms spatial experience by “enfolding remote [and latent] contexts inside the present context” (de Souza e Silva). A range of GPS navigation systems adapted for vision-impaired users are currently on the market. Typically, these systems convert GPS information into text-to-speech instructions and are either standalone devices, such as the Trekker Breeze, or they use the compass, accelerometer, and 3G or WiFi functions found on most smart phones, such as Loadstone. Whilst both these products are adequate in guiding a vision-impaired user from their home to a supermarket, there are significant differences in their interfaces and data architectures. Trekker Breeze is a standalone hardware device that produces talking menus, maps, and GPS information. While its navigation functionality relies on a worldwide radio-navigation system that uses a constellation of 24 satellites to triangulate one’s position (May and LaPierre 263-64), its map and text-to-speech functionality relies on data on a DVD provided with the unit. Loadstone is an open source software system for Nokia devices that has been developed within the vision-impaired community. Loadstone is built on GNU General Public License (GPL) software and is developed from private and user based funding; this overcomes the issue of Trekker Breeze’s reliance on trading policies and pricing models of the few global vendors of satellite navigation data. Both products have significant shortcomings if viewed in the broader context of the five sub-tasks involved in shopping described above. Trekker Breeze and Loadstone require that additional devices be connected to it. In the case of Trekker Breeze it is a tactile keypad, and with Loadstone it is an aftermarket screen reader. To function optimally, Trekker Breeze requires that routes be pre-recorded and, according to a review conducted by the American Foundation for the Blind, it requires a 30-minute warm up time to properly orient itself. Both Trekker Breeze and Loadstone allow users to create and share Points of Interest (POI) databases showing the location of various places along a given route. Non-standard or duplicated user generated content in POI databases may, however, have a negative effect on usability (Ellis and Kent 2). Furthermore, GPS-based navigation systems are accurate to approximately ten metres, which means that users must rely on their own mobility skills when they are required to change direction or stop for traffic. This issue with GPS accuracy is more pronounced when a vision-impaired user is approaching a supermarket where they are likely to encounter environmental hazards with greater frequency and both pedestrian and vehicular traffic in greater density. Here the relations between space defined and spaces poorly defined or undefined by the GPS device interact to produce the supermarket surrounds as a disabling space (Galloway). Prototype Systems for Supermarket Navigation and Product SelectionIn the discussion to follow, I look at two prototype systems using QR codes and RFID that are designed to be used in-store by vision-impaired shoppers. Shop Talk is a proof of concept system developed by researchers at Utah State University that uses synthetic verbal route directions to assist vision impaired shoppers with supermarket navigation, product search, and selection (Nicholson et al.). Its hardware consists of a portable computational unit, a numeric keypad, a wireless barcode scanner and base station, headphones for the user to receive the synthetic speech instructions, a USB hub to connect all the components, and a backpack to carry them (with the exception of the barcode scanner) which has been slightly modified with a plastic stabiliser to assist in correct positioning. Shop Talk represents the supermarket environment using two data structures. The first is comprised of two elements: a topological map of locomotor space that allows for directional labels of “left,” “right,” and “forward,” to be added to the supermarket floor plan; and, for navigation of haptic space, the supermarket inventory management system, which is used to create verbal descriptions of product information. The second data structure is a Barcode Connectivity Matrix (BCM), which associates each shelf barcode with several pieces of information such as aisle, aisle side, section, shelf, position, Universal Product Code (UPC) barcode, product description, and price. Nicholson et al. suggest that one of their “most immediate objectives for future work is to migrate the system to a more conventional mobile platform” such as a smart phone (see Mobile Shopping). The Personalisable Interactions with Resources on AMI-Enabled Mobile Dynamic Environments (PRIAmIDE) research group at the University of Deusto is also approaching Ambient Assisted Living (AAL) by exploring the smart phone’s sensing, communication, computing, and storage potential. As part of their work, the prototype system, BlindShopping, was developed to address the issue of assisted shopping using entirely off-the-shelf technology with minimal environmental adjustments to navigate the store and search, browse and select products (López-de-Ipiña et al. 34). Blind Shopping’s architecture is based on three components. Firstly, a navigation system provides the user with synthetic verbal instructions to users via headphones connected to the smart phone device being used in order to guide them around the store. This requires a RFID reader to be attached to the tip of the user’s white cane and road-marking-like RFID tag lines to be distributed throughout the aisles. A smartphone application processes the RFID data that is received by the smart phone via Bluetooth generating the verbal navigation commands as a result. Products are recognised by pointing a QR code reader enabled smart phone at an embossed code located on a shelf. The system is managed by a Rich Internet Application (RIA) interface, which operates by Web browser, and is used to register the RFID tags situated in the aisles and the QR codes located on shelves (López-de-Ipiña and 37-38). A typical use-scenario for Blind Shopping involves a user activating the system by tracing an “L” on the screen or issuing the “Location” voice command, which activates the supermarket navigation system which then asks the user to either touch an RFID floor marking with their cane or scan a QR code on a nearby shelf to orient the system. The application then asks the user to dictate the product or category of product that they wish to locate. The smart phone maintains a continuous Bluetooth connection with the RFID reader to keep track of user location at all times. By drawing a “P” or issuing the “Product” voice command, a user can switch the device into product recognition mode where the smart phone camera is pointed at an embossed QR code on a shelf to retrieve information about a product such as manufacturer, name, weight, and price, via synthetic speech (López-de-Ipiña et al. 38-39). Despite both systems aiming to operate with as little environmental adjustment as possible, as well as minimise the extent to which a supermarket would need to allocate infrastructural, administrative, and human resources to implementing assistive technologies for vision impaired shoppers, there will undoubtedly be significant establishment and maintenance costs associated with the adoption of production versions of systems resembling either prototype described in this paper. As both systems rely on data obtained from a server by invoking Web services, supermarkets would need to provide in-store WiFi. Further, both systems’ dependence on store inventory data would mean that commercial versions of either of these systems are likely to be supermarket specific or exclusive given that there will be policies in place that forbid access to inventory systems, which contain pricing information to third parties. Secondly, an assumption in the design of both prototypes is that the shopping task ends with the user arriving at home; this overlooks the important task of being able to recognise products in order to put them away or to use at a later time.The BCM and QR product recognition components of both respective prototypic systems associates information to products in order to assist users in the product search and selection sub-tasks. However, information such as use-by dates, discount offers, country of manufacture, country of manufacturer’s origin, nutritional information, and the labelling of products as Halal, Kosher, containing alcohol, nuts, gluten, lactose, phenylalanine, and so on, create further challenges in how different data sources are managed within the devices’ software architecture. The reliance of both systems on existing smartphone technology is also problematic. Changes in the production and uptake of mobile communication devices, and the software that they operate on, occurs rapidly. Once the fit-out of a retail space with the necessary instrumentation in order to accommodate a particular system has occurred, this system is unlikely to be able to cater to the requirement for frequent upgrades, as built environments are less flexible in the upgrading of their technological infrastructure (Kellerman 148). This sets up a scenario where the supermarket may persist as a disabling space due to a gap between the functional capacities of applications designed for mobile communication devices and the environments in which they are to be used. Lists and Disabling Spatial PracticeThe development and provision of access to assistive technologies and the data they rely upon is a commercial issue (Ellis and Kent 7). The use of assistive technologies in supermarket-spaces that rely on the inter-functional coordination of multiple inventories may have the unintended effect of excluding people with disabilities from access to legitimate content (Ellis and Kent 7). With de Certeau, we can ask of supermarket-space “What spatial practices correspond, in the area where discipline is manipulated, to these apparatuses that produce a disciplinary space?" (96).In designing assistive technologies, such as those discussed in this paper, developers must strive to achieve integration across multiple data inventories. Software architectures must be optimised to overcome issues relating to intellectual property, cross platform access, standardisation, fidelity, potential duplication, and mass-storage. This need for “cross sectioning,” however, “merely adds to the muddle” (Lefebvre 8). This is a predicament that only intensifies as space and objects in space become increasingly “representable” (Galloway), and as the impetus for the project of spatial politics for the vision impaired moves beyond representation to centre on access and meaning-making.ConclusionSupermarkets act as sites of hegemony, resistance, difference, and transformation, where the vision impaired and their allies resist the “repressive socialization of impaired bodies” through their own social movements relating to environmental accessibility and the technology assisted spatial practice of shopping (Gleeson 129). It is undeniable that the prototype technologies described in this paper, and those like it, indeed do have a great deal of emancipatory potential. However, it should be understood that these devices produce representations of supermarket-space as a simulation within a framework that attempts to mimic the real, and these representations are pre-determined by the industrial, technological, and regulatory forces that govern their production (Lefebvre 8). Thus, the potential of assistive technologies is dependent upon a range of constraints relating to data accessibility, and the interaction of various kinds of lists across the geographic area that surrounds the supermarket, locomotor, haptic, and search spaces of the supermarket, the home-space, and the internal spaces of a shopper’s imaginary. These interactions are important in contributing to the reproduction of disability in supermarkets through the use of assistive shopping technologies. The ways by which people make and read shopping lists complicate the relations between supermarket-space as location data and product inventories versus that which is intuited and experienced by a shopper (Sutherland). Not only should we be creating inventories of supermarket locomotor, haptic, and search spaces, the attention of developers working in this area of assistive technologies should look beyond the challenges of spatial representation and move towards a focus on issues of interoperability and expanded access of spatial inventory databases and data within and beyond supermarket-space.ReferencesDe Certeau, Michel. The Practice of Everyday Life. Berkeley: University of California Press, 1984. Print.De Souza e Silva, A. “From Cyber to Hybrid: Mobile Technologies As Interfaces of Hybrid Spaces.” Space and Culture 9.3 (2006): 261-78.Ellis, Katie, and Mike Kent. Disability and New Media. New York: Routledge, 2011.Farman, Jason. Mobile Interface Theory: Embodied Space and Locative Media. New York: Routledge, 2012.Galloway, Alexander. “Are Some Things Unrepresentable?” Theory, Culture and Society 28 (2011): 85-102.Gleeson, Brendan. Geographies of Disability. London: Routledge, 1999.Goggin, Gerard. Cell Phone Culture: Mobile Technology in Everyday Life. London: Routledge, 2006.Haber, Alex. “Mapping the Void in Perec’s Species of Spaces.” Tattered Fragments of the Map. Ed. Adam Katz and Brian Rosa. S.l.: Thelimitsoffun.org, 2009.Jolley, William M. When the Tide Comes in: Towards Accessible Telecommunications for People with Disabilities in Australia. Sydney: Human Rights and Equal Opportunity Commission, 2003.Keaggy, Bill. Milk Eggs Vodka: Grocery Lists Lost and Found. Cincinnati, Ohio: HOW Books, 2007.Kellerman, Aharon. Personal Mobilities. London: Routledge, 2006.Kleege, Georgia. “Blindness and Visual Culture: An Eyewitness Account.” The Disability Studies Reader. 2nd edition. Ed. Lennard J. Davis. New York: Routledge, 2006. 391-98.Lefebvre, Henri. The Production of Space. Oxford, UK: Blackwell, 1991.López-de-Ipiña, Diego, Tania Lorido, and Unai López. “Indoor Navigation and Product Recognition for Blind People Assisted Shopping.” Ambient Assisted Living. Ed. J. Bravo, R. Hervás, and V. Villarreal. Berlin: Springer-Verlag, 2011. 25-32. May, Michael, and Charles LaPierre. “Accessible Global Position System (GPS) and Related Orientation Technologies.” Assistive Technology for Visually Impaired and Blind People. Ed. Marion A. Hersh, and Michael A. Johnson. London: Springer-Verlag, 2008. 261-88. Nicholson, John, Vladimir Kulyukin, and Daniel Coster. “Shoptalk: Independent Blind Shopping Through Verbal Route Directions and Barcode Scans.” The Open Rehabilitation Journal 2.1 (2009): 11-23.Perec, Georges. Species of Spaces and Other Pieces. Trans. and Ed. John Sturrock. London: Penguin Books, 1997.Schillmeier, Michael W. J. Rethinking Disability: Bodies, Senses, and Things. New York: Routledge, 2010.Sutherland, I. “Mobile Media and the Socio-Technical Protocols of the Supermarket.” Australian Journal of Communication. 36.1 (2009): 73-84.

M/C Journal

Oct 12, 2012
Suneel Jethani

The expanded core curriculum (ECC) is an essential part of educating students with visual impairments (that is, those who are blind or have low vision). Professionals and families alike acknowledge that students with visual impairments, including those with additional disabilities, have unique educational needs that go far beyond academics to insure success in adult life. The nine areas of the ECC have provided a framework for teachers of students with visual impairments and certified orientation and mobility specialists to design instruction that is based on credible assessment and sound teaching strategies. In fact, the Individuals with Disabilities Education Act (IDEA, 2004), stipulates that, in addition to addressing academic achievement, Individualized Education Programs (IEPs) must also address the functional performance of students with visual impairments and provide specialized instruction related to students' specific disabilities. The Council of Schools for the Blind (COSB) believes strongly in the implementation of the ECC. Many schools for students who are visually impaired have taken leadership roles in initiating and implementing the ECC curriculum. For example, Texas School for the Blind and Visually Impaired has provided numerous publications related to the ECC, and a portion of their web site is dedicated to resources supporting assessment and instruction in the ECC. California School for the Blind has aligned core content in reading, language arts, and mathematics with braille standards and activities related to the ECC. Many others, including Perkins School for the Blind, operate short courses that focus on various elements of the ECC. Because of the way in which specialized schools are organized, instruction in the ECC along with core content can naturally occur, allowing educators to focus on disability-specific curricula in a concentrated way. Braille instruction, for example, can take place in the classroom during literacy activities, in a special braille class, in the assistive technology lab, and in the community during an orientation and mobility lesson. Schools for the blind also provide educational opportunities for students who receive the majority of their educational support in local school districts. Short courses of five days or fewer give students the opportunity to learn activities of daily living, social skills, self-determination, and knowledge about visual impairment. Also, summer programs provided by specialized schools provide educational experiences in independent living, career education, and the transition from school to work. Although specialized schools have been proactive in initiating programs to implement the ECC, COSB strongly acknowledges that a concerted effort must be undertaken to ensure that language acknowledging the essential nature of the ECC is included when IDEA is reauthorized. Recently, in a letter written to U.S. Secretary of Education Ame Duncan, COSB and the American Foundation for the Blind (AFB) wrote: The U.S. Department of Education has itself recognized the need to provide this array of critical services in policy guidance issued a decade ago. …

In August 2008, the American Printing House for the Blind (APH) brought together an advisory group to provide guidance and clarity on a range of issues related to cortical visual impairment (CVI) as those issues relate to the development of products. The internationally drawn CVI Advisory Group, with members suggested by APH ex officio trustees and consultants, represents a continuing effort by APH to serve the growing group of students with CVI who are registered for Federal Quota funds. Previous activities conducted by APH on behalf of these students have included improving the Federal Quota registration process by better defining eligibility criteria; hosting a CVI Synergy meeting in Louisville, Kentucky; identifying existing APH products that serve the unique needs of this population; developing and manufacturing new products for students with CVI; creating a CVI web site; and providing information on APH products that are related to students with CVI through workshops of the APH National Instructional Partnership. DEFINITION OF CVI: A WORKING DEFINITION FOR EDUCATIONAL SERVICES CVI is defined as impaired vision that is due to bilateral dysfunction of the optic radiations or visual cortex or both. It can coexist with ocular and ocular motor disorders and can be the result of perinatal brain dysfunction or be caused by trauma. Approximately 30%-40% of children with visual impairments have CVI (see Figure 1, which can be viewed in an area dedicated to CVI on the American Foundation for the Blind's web site at ). One concern of professionals in the field of education of students with visual impairments is to establish a standard definition of CVI. Accordingly, the purpose of this article is to clarify the differences between children who qualify for services from vision educators and those who have visual processing difficulties that are not considered visual impairment. Our perspective is that all children who have CVI should be classified as visually impaired and receive the necessary services, regardless of the severity of the degree of CVI or additional disabilities. A child with CVI is distinguished from a child with learning disabilities or developmental disabilities by the following criteria: (1) an eye examination that cannot fully explain the child's use of vision; (2) a history or presence of neurological problems, even when the child's brain-imaging studies may appear normal (Dutton, 2008); and (3) the presence of the behavioral or visual responses that are collectively associated with CVI. In most North American jurisdictions, low vision is defined as a reduction in visual acuity no better than 20/70 (6/21) but better than 20/200 (6/60) in the better eye with the best correction. Legal blindness is defined as visual acuity no better than 20/200 (6/60) in the better eye with the best correction. Legal blindness is also defined as a central visual field that is no greater than 20 degrees. Using this framework, CVI should be defined, albeit arbitrarily, by a reduction in visual acuity, in the visual fields, or in a child's ability to see compared to other children of the same age. Unfortunately, traditional methods of precisely determining acuity or visual field function in children with CVI are problematic. Because children with CVI frequently have additional disabilities, it is often difficult to measure visual acuity. When it is possible to do so, standard visual acuity testing should be performed. Electrophysiological measures, such as visual evoked potential acuities, may also be used. When warranted, visual acuities should be measured using forced-choice preferential looking acuities or estimating visual function through the identification of sized objects at specific distances. Dutton (2008) and others have proposed a theoretical construct for classifying higher-level visual processing. This framework considers the effects of damage to the dorsal and ventral streams of the brain to explain visual dysfunction. …

You have accessThe ASHA LeaderFeature1 Sep 2009Audiologic Management of the Older Patient Harvey AbramsPhD, CCC-A Harvey Abrams Google Scholar More articles by this author , PhD, CCC-A https://doi.org/10.1044/leader.FTR4.14112009.14 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Ken is 87 years old and has returned to your clinic for the fourth time in two months. He is now wearing his third pair of high-end digital hearing aids since his initial evaluation. He is dissatisfied with this latest pair because he has difficulty inserting them correctly and changing the batteries, doesn’t know why the hearing aids have a little button, and cannot understand conversations around the table because of background noise from others in the dining room at the senior center. Ken’s friend has hearing aids from another company and Ken wants to know if those would work better for him. How will you advise him? Ken is representative of the patients we will increasingly see in our audiology practices in the future. From 2000 to 2030 the number of Americans older than 65 will double from 34.8 million (12% of the population) to 70.3 million (20%). The likelihood that an American reaching the age of 65 will live to age 90 has nearly doubled since 1960. By 2040 an estimated 40% of 65-year-olds will live into their 90s. (From the Experience Corps Web site.) With increased age comes the increased likelihood of hearing loss. As illustrated in Figure A [PDF], the number of people with hearing loss in the United States is anticipated to increase by almost 20 million over the next 40 years (Kochkin, 2005). In fact, these projections likely underestimate the true prevalence of hearing loss, as they are based on the number of people “admitting” their hearing loss (Kochkin, personal communication). The actual numbers are likely to be much higher as audiometry would reveal mild hearing loss that may not be perceptible to the individual. The increased prevalence of hearing loss will have a significant impact on audiologic practice, as hearing aid adoption rates are clearly associated with advancing age (see Figure 1 [PDF]). Although these statistics suggest unprecedented opportunities for audiologists involved in the selection and fitting of hearing aids, older patients also may present significant challenges as their approach toward audiologic rehabilitation will be influenced by the physiologic, psychoacoustic, and psychosocial changes that occur with aging. Of course, any discussion of aging begs the question, “How old is old?” There is no such number; it is more effective to understand the effects of aging on the auditory system and their implications for audiologic management. In fact, making assumptions about an individual’s auditory and communication capacity on the basis of chronological age alone would be irresponsible, as individual differences do not disappear as we age. Indeed, outcomes with hearing aids likely will be poor without a careful and comprehensive evaluation that includes an assessment of motivation, needs, and expectations. Age-related hearing loss is associated with various types of auditory system dysfunction, peripheral or central, which accompany aging and cannot be attributed to extraordinary ototraumatic, genetic, or pathological conditions. Hearing loss implies a deficit in absolute thresholds and/or suprathreshold perception (Willott, 1991). Anatomic and Physiologic Changes Age-related changes to the auditory system occur from the pinna to the auditory cortex (see summary on p. 16). The implications for audiologic management, including the selection and fitting of hearing aids, will vary with the location and severity of changes in the auditory system. For example, changes to the outer and middle ears likely will have minimal effect on auditory processing and subsequently little influence on hearing aid decisions, with the possible exception of earmold style and material. On the other hand, changes in the inner ear often will have a significant impact on auditory function as the result of a loss of audibility, widening auditory filters, and reduced dynamic range. Age-related cochlear changes frequently lead to difficulties understanding speech in the presence of background noise or multiple talkers or in highly reverberant environments. Despite advances in digital signal processing, hearing aid success may be limited as a function of the extent of sensory cell loss, specifically inner hair cells and spiral ganglion cells. Changes in the central auditory system may be more problematic because they affect high-level auditory processing such as temporal and binaural processing and occur in addition to changes that affect cochlear structures. Recently, there has been more attention given to the importance of considering the cognitive effects of aging such as cognitive “slowing” and reduced working memory on the outcomes of audiologic intervention and approaches to management (Pichora-Fuller, 2003; Pichora-Fuller & Souza, 2003; Stewart & Wingfield, 2009). Psychosocial Implications For many individuals, growing old is a rewarding phase of life with increased time to spend with family, travel, or become involved in new, post-retirement activities. For others, however, it is a time of reduced income, increased health issues, loss of loved ones, and loss of purpose. When sensory function deterioration is added to these issues, the effect on quality of life can be significant. The psychosocial impact of hearing loss on older individuals can be examined within the context of the International Classification of Functioning, Disability, and Health (ICF; WHO, 2001). The WHO-ICF is a bio-psychosocial model that codifies an individual’s health condition into the broad dimensions of body structure and function, activity, and participation (Chisolm & Abrams, 2008). Figure 2 [PDF] illustrates how these dimensions interact with the health condition as influenced by environmental (e.g., social attitudes, community resources) and contextual (e.g., income, gender, age) factors. As an example, Ken, the 87-year-old patient described previously, has an impairment of a body structure (the auditory system) that results in an activity limitation (ability to understand conversations in the dining room) that leads to participation restriction (no longer engages in conversation with tablemates). His disability is further aggravated by environmental factors (poor acoustics and lack of appropriate assistive technology) and personal factors (inability to afford assistive technology). Clearly, this unhappy scenario can lead to additional psychosocial consequences such as depression, loneliness, irritation, anger, insecurity, and social isolation (see Heine & Browning, 2001 for a review of the psychosocial consequences of sensory loss in the elderly). It is important to note that hearing loss does not usually occur in isolation in the elderly, but is often accompanied by visual impairment as the result of cataracts, diabetic neuropathy, glaucoma, or age-related macular degeneration (Rosenbloom, 1992). It is estimated that 19% of older individuals who are not living in a facility have dual-sensory impairment (Hickson et al., 1999). Dual-sensory impairment creates additional burdens for the older patient and can lead to even deeper social isolation, loneliness, and depression. Pre-fitting Considerations Ken brings with him a complex set of needs, wants, expectations, prejudices, medical and psychosocial limitations, and lifetime experiences. It is never appropriate to develop a treatment plan based primarily on an audiogram for any patient, and it is particularly inappropriate for an older individual. Before any decision about amplification can be made, it is important to consider the patient’s motivation, needs, and expectations. This consideration is best accomplished through the following questions: Why are you here? The patient’s response to this question can reveal his or her motivation for the visit. If the answer is, “I live in a retirement home and want to be able to understand others at the dining room table,” then the clinician can be assured that the patient recognizes a problem, has taken ownership of it, and is taking a significant step toward resolution. On the other hand, if he answers, “My daughter set up this appointment. She thinks I can’t hear her or the grandchildren,” then the success of audiologic management may be limited unless the patient can, through counseling and involvement of family members, accept ownership of the problem and solution. This approach requires counseling skills and time to explore issues around motivation and family dynamics that need to be resolved for successful treatment (for information about counseling, see Luterman, 2008). In absence of strong motivation, the patient may be unwilling to invest the time and effort required to become a successful hearing aid user and will likely reject the hearing instruments. What’s important to you? If the patient has adequate motivation, the next step is to determine the patient’s perceived needs. What does the patient want from the therapeutic experience? A number of needs-assessment instruments are available, including the Hearing Handicap Inventory for the Elderly (HHIE; Ventry & Weinstein, 1982) and the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox & Alexander, 1995). The Client-Oriented Scale of Improvement (COSI; Dillon, James, & Ginis, 1997) may be particularly effective because it determines not only the patient’s needs, but also the relative importance the patient places on addressing specific needs. The COSI has gained popularity among clinicians who assume that by focusing on and measuring the effects of treating problems relevant to the patient, the outcomes measured will most accurately reflect the true functional impact of intervention as perceived by the patient (Chisolm & Abrams, 2008). What do you expect? Although there appears to be no clear relationship between pre-fitting expectations and satisfaction with hearing aids (Cox & Alexander, 2000), understanding the patient’s expectations may help in counseling the patient to establish reasonable expectations based on the evaluation. Patient expectations may be unreasonably positive (“hearing aids will help me in all situations”) or negative (“everyone will notice that I am wearing hearing aids”). The Expected Consequences of Hearing Aid Ownership (ECHO; described in Cox & Alexander, 2000) is an instrument designed to determine the patient’s expectations for hearing aids across several domains, including positive effect, service and cost, negative features, and personal image. Hearing Aid Selection In addition to providing the routine audiologic examination, the clinician should consider the physical and cognitive abilities of the patient. The patient’s manual dexterity and visual acuity can limit instrument choice to those that are easy to insert, remove, and operate and use a large battery. The patient’s cognitive abilities might influence technology decisions such as whether to fit unilaterally or bilaterally or whether to provide automatic or manual options for gain control and program changes. Newer-generation hearing instruments have rechargeable batteries that last up to 24 hours. Automatic features eliminate the need to change programs manually. Despite the availability of advanced signal-processing instruments, older people with hearing loss will likely continue to experience problems understanding speech in less-than-optimal listening environments. Consequently, part of the hearing aid selection process should consider assistive technology (i.e., the selected hearing instrument should have the capability of incorporating FM, Bluetooth, and/or direct audio input technology). Two excellent reviews of the issues associated with older adults’ compromised cognitive and auditory abilities and their implications for audiologic management are provided by Kricos (2006) and Pichora-Fuller and Singh (2006). Hearing Aid Verification and Treatment Validation Although real-ear verification of gain and output represents the current standard of audiologic care (American Academy of Audiology, 2005; ASHA, 2006), the use of probe-microphone measures are particularly critical in the elderly population; disappointment and subsequent rejection of hearing instruments because of inadequate or inappropriate gain and/or loudness discomfort could result in the patient’s reluctance to pursue amplification. Validating treatment success with a standardized instrument such as the COSI allows the clinician and patient to determine the extent to which treatment goals were achieved and provides an important opportunity to modify the treatment plan to resolve more adequately any unmet or partially met goals. Follow-up Services Regular post-fitting follow-up is critical to treatment success for older people. These patients may forget the new and complex information provided at the hearing aid fitting, including information related to batteries, cleaning, and operation. They are more likely to become frustrated with the quality of amplified sound and the time needed to adjust to amplification. Post-fitting group audiologic rehabilitation programs that focus on counseling and communication skills training may be particularly valuable for this patient population (Abrams et al., 1992; Chisolm et al., 2004; Kricos et al., 1992). The recent development of at-home, computer-based, auditory rehabilitation programs (e.g., LACE™; Sweetow & Sabes, 2006) provides another option for post-fitting intervention for those comfortable with computer technology. Patient Self-Management Collaborative self-management (CSM), an emerging treatment approach in managing chronic illnesses, may have implications for successful audiologic management of the older patient with hearing loss. CSM (also referred to as patient self-management) emphasizes the partnership among the health care professional, the patient, and the family that guides the patient’s self-management (Hodder, 2007). The role of the provider is modified from a prescriber or director of care to a facilitator who helps the patient take charge of his or her condition, make informed care decisions, and adopt healthy behaviors. The clinician provides information, resources, and supportive care. CSM encourages everyone to work together to help manage the patient’s condition, with a focus on the patient’s needs, abilities, values, and preferences. Families and others in the patient’s support network are welcomed as partners in care who share information and create a care plan together. (Additional information on collaborative self-management can be found on the California Healthcare Foundation’s Web site. Patient self-management can be applied to audiologic care through the following steps: Engage patients to help them identify needed changes from their perspective. Engagement involves active listening and obtaining the details about the impact of hearing loss to identify key areas of concern. When patients see that the clinician is interested in their perspective, they are more likely to follow advice and be open to and interested in taking responsibility for their hearing loss. Recognize ambivalence and explore importance of treatment to help the patient not only identify why it may be important to “hear better” but to also to identify and accept mixed feelings about treatment (“I want to hear better but I don’t want to wear hearing aids …”). When patients recognize their ambivalence and that ambivalence is accepted and validated by the clinician, they may be more likely to accept change. Collaborate in action planning by using a step-by-step strategy that is achievable, specific, and focused on specific behaviors (e.g., “I will wear my hearing aids from 8 a.m. to 10 a.m. on the first day, from 8 a.m. to 12 noon on the second day,” etc.). Older patients can present a significant challenge to audiologists. Changes in the structure and function of the auditory system, combined with age-related visual, physical, cognitive, and psychosocial decline, require careful and comprehensive the management of hearing loss. A clinical protocol that works well for young patients requires modification of all steps, from the determination of motivation and expectations, through the evaluation of visual, dexterity, and cognitive status, to the establishment of post-fitting programs to improve communication. An approach that encourages collaborative self-management may lead to better long-term positive outcomes and improved quality of life for the older patient with hearing loss. Anatomic and Physiologic Considerations The follow age-related changes to the auditory system are summarized from Chisolm, Willott, and Lister (2003): Outer Ear Enlargement of the pinna Increased hair growth in and around ear canal opening Production of excessive cerumen Changes in skin properties leading to loss of elasticity and dehydration Collapsed ear canals Middle Ear Thinning, stiffening, loss of vascularity of the typannic membrane Arthritic changes in the ossicular joints Atrophy and degeneration of the middle ear muscles and ossicular ligaments Ossification of the ossicles Calcification of the cartilaginous portion of the eustachian tube and decline of muscles that open the tube Inner Ear Loss of sensory cells (outer and inner hair cells) Loss of supporting cells (Hensens and Deiters cells) Loss of spiral ganglion cells Changes in the stria vascularis Changes in the physical properties of the basilar membrane Submicroscopic changes in cell structure Central Auditory System Shrinkage and reduced volume of nerve cells Alterations in connectional pathways Neurochemical changes in nerve cells Find Out More Older Adults and Hearing Loss Adult Audiologic Rehabilitation References Abrams H., Hnath Chisolm T., Guerreiro S., & Ritterman S. (1992). The effects of intervention strategy on self-perception of hearing handicap.Ear & Hearing, 13, 371–377. Google Scholar American Academy of Audiology. (2005). Guidelines for the audiologic management of adult hearing impairment.Audiology Today, 18, 6–10. Google Scholar American Speech-Language-Hearing Association. (2006). Preferred Practice Patterns for the Profession of Audiology [Preferred Practice Patterns]. Available from www.asha.org/policy. Google Scholar Chisolm T., Abrams H. & McArdle R. (2004). Short- and Long-Term Outcomes of Adult Audiological Rehabilitation.Ear & Hearing, 25, 464–477. Google Scholar Chisolm T., Willott J., & Lister J. (2003). The aging auditory system: anatomic and physiologic changes and implications for rehabilitation.International Journal of Audiology, 42, S3–2SI0. Google Scholar Chisolm T., & Abrams H. (2008). Outcome measures and evidence-based practice.(2nd ed). In Hosford-Dunn H., Roesser R., & Valente M. (Eds.) Audiology: Practice Management. New York: Thieme, 171–194. Google Scholar Cox R., & Alexander G. (1995). The Abbreviated Profile of Hearing Aid Benefit.Ear & Hearing, 16, 176–186. MedlineGoogle Scholar Cox R., & Alexander G. (2000). Expectations about hearing aids and their relationship to fitting outcome.Journal of the American Academy of Audiology, 11, 368–382. CrossrefGoogle Scholar Dillon H., James A., & Ginis J. (1997). Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids.Journal of the American Academy of Audiology, 8, 27–43. Google Scholar Experience Corps.Fact sheet on aging in America.Retrieved May 28, 2009, from http://www.experiencecorps.org/research/factsheet.html. Google Scholar Heine C., & Browning J. (2002). Communication and psychosocial consequences of sensory loss in older adults: overview and rehabilitation directions.Disability and Rehabilitation, 24, 763–773. Google Scholar Hodder R. (2007). Collaborative self-management education in asthma and COPD.CPJ/RPC, 140, S28–S29. Google Scholar Hickson L., Lind C., Worrall L., Yiu E., Barnett H., & Lovie-Kitchin J. (1999). Hearing and vision in healthy older Australians: objective and self reported measures.Advances in Speech Language Pathology, 1, 95–105. Google Scholar Kochkin S. (2005). MarkeTrak VII: Hearing loss population tops 31 million people.Hearing Review, 12, 16–29. Google Scholar Kricos P., Homes A., & Doyle D. (1992) Efficacy of a communication training program for hearing impaired elderly adults.Journal of the Academy of Rehabilitative Audiology, 25, 69–80. Google Scholar Kricos P. (2006). Audiologic management of older adults with hearing loss and compromised cognitive/psychoacoustic auditory processing capabilities.Trends in Amplification, 10, 1–21. CrossrefGoogle Scholar Luterman D. (2008). Counseling Persons with Communication Disorders and Their Families. Austin, TX: Pro-Ed. Google Scholar Pichora-Fuller M.K. (2003). Cognitive aging and auditory information processing.International Journal of Audiology, 42, 2S26–2S32. Google Scholar Pichora-Fuller M.K., & Souza P. (2003). Effects of aging on auditory processing of speech.International Journal of Audiology, 42, 2S11–2S16. Google Scholar Pichora-Fuller M.K., & Singh G. (2006). Effects of age on auditory and cognitive processing: implications for hearing aid fitting and audiologic rehabilitation.Trends in Amplification, 10, 29–59. CrossrefGoogle Scholar Rosenbloom A.A. (1992). Physiological and functional aspects of aging, vision, and visual impairment.In: Orr AL (ed.) Vision and Ageing. Crossroads for Service Delivery. New York: American Foundation for the Blind, 47–68. Google Scholar Stewart R., & Wingfield A. (2009). Hearing loss and cognitive effort in older adults’ report accuracy for verbal materials.Journal of the American Academy of Audiology, 20, 147–154. Google Scholar Sweetow R., & Sabes J. (2006). The need for and development of an adaptive listening and communication enhancement (LACE™) program.Journal of the American Academy of Audiology, 17, 538–558. CrossrefGoogle Scholar Ventry I., & Weinstein B. (1982). The hearing handicap inventory for the elderly: a new tool.Ear and Hearing, 3, 128–134. CrossrefGoogle Scholar Willott J.F. (Ed.). (2001). Handbook of Mouse Auditory Research: From Behavior to Molecular Biology.: Boca Raton, FL: CRC Press. Google Scholar World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva. World Health Organization. Available at http://www3.who.int/icf/. Google Scholar Author Notes Harvey Abrams, PhD, CCC-A, is director of audiology research at Starkey Laboratories, Inc., in Eden Prarie, Minn. He was formerly the associate chief of staff for research and development at the Bay Pines (Fla.) VA Healthcare System, and professor in the Department of Communication Sciences and Disorders at the University of South Florida (Tampa). Contact him at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 11September 2009 Get Permissions Add to your Mendeley library History Published in print: Sep 1, 2009 Metrics Current downloads: 227 Topicsasha-topicsleader_do_tagasha-article-typesCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...

For students with disabilities, using the online educational media employed in most general education classrooms may be challenging, since much mainstream programming is not accessible. Online educational media take the form of integrated learning modules that contain content to enhance students' learning and support teachers' instruction. For students, each integrated learning module typically includes a full-length educational video and additional educational materials (such as still images, related articles, links to relevant web sites, self-study assessments, and activities). For example, the sample integrated learning module in the Universal eLearner (the Internet-based educational materials that are discussed next) contains a vocabulary list, a story, a story quiz, a video, three student activities, and a unit quiz. These online activities are designed to provide a comprehensive learning unit on a topic or to supplement traditional classroom instruction. Research has underscored the effectiveness of integrated learning modules in improving test scores in math (Taylor, 1999) and science (Cantrell, Pekcan, & Itani, 2006), but such modules are available in almost all content areas and at all educational levels from elementary school to postgraduate programs. The Universal eLearner is an online integrated learning module, under development, that incorporates accessible technology, universal design for learning, and best practices for online education. The American Foundation for the Blind and Bridge Multimedia have just completed a three-year grant through the National Institute on Disability and Rehabilitation Research, U.S. Department of Education, to develop and test the latest version of the Universal eLearner. The Universal eLearner, although not a finished product, has been developed and fieldtested with students with disabilities (including those with visual impairments, hearing impairments, orthopedic impairments, and learning disabilities), as well as students who are English language and typically developing students. The evaluations conducted under the grant focused on the accessibility and usability of the Universal eLearner to provide feedback to the development team to improve the product further. An advisory board, consisting of professionals and consumers with all forms of disabilities, has also contributed their expertise to the development of the Universal eLearner. The prototype versions of the Universal eLearner are designed for an upper elementary school social studies unit using educational materials from the Pearson Digital Learning Knowledge Box series, but many of the outcomes of the testing of the Universal eLearner are applicable to integrated learning modules for any grade level and in any subject area. This report presents some of the outcomes from the grant-funded project to help professionals understand the needs of students with disabilities in relation to integrated learning modules and to offer suggestions for anyone who is developing universally accessible online educational programming. WHO BENEFITS FROM UNIVERSAL ACCESSIBILITY? When products are created using universal design, the needs of people with physical and sensory disabilities are taken into account and accessibility features and options are built into the product (Flores, 2008). In the classroom, specialized learners include not only students who are blind or have low vision, students who are deaf or hard of hearing, and students with physical disabilities, but also students with learning disabilities, English language learners, and students with cognitive impairments. Each group faces its own significant learning challenges. Traditionally, students with all forms of disabilities have been provided instructional materials that have been designed for typical students, not those that have been adapted to meet their needs. These students also often receive instructional materials that are targeted exclusively toward students in their disability group that do not match the general education curriculum in rigor and content, which increases costs for school systems. …

The prevalence of visual impairment (that is, blindness and low vision) is increasing in the United States, especially in persons aged 65 and older, with more than half of all people who are blind in this age demographic (Centers for Disease Control and Prevention, 2004; National Eye Institute, 2006; Strobel, 2003). It has been estimated that about 6.5 million Americans aged 55 and older report vision loss, and this number is expected to double by 2030 (Dinsmore & Kirchner, 2004; Shi & Singh, 2004; Strobel, 2003). Furthermore, the use of prescription medications will rise because persons who are older also tend to use more prescription medications (American Foundation for the Blind, 2007), with more than 40% of older persons taking at least five different prescription drugs (Wilson et al., 2007). Because of these factors, it is important to determine if, and how, these individuals are reading the labels of their prescription medications. The lack of access to the printed information related to medication can be a barrier for a person who is visually impaired to manage his or her prescriptions and health information optimally (Dinsmore & Kirchner, 2004). The Rehabilitation Act of 1973 and the Americans with Disabilities Act mandate that the print information commonly used by sighted persons (referred to as effective communication) must be accessible to those who cannot access the information in the typical manner (U.S. Department of Health & Human Services, Office for Civil Rights, n.d.; U.S. Department of Justice, Civil Rights Division, Disability Rights Section, 2005). In addition, Little (2006) reported that the Health Insurance Portability and Accountability Act (2002) requires protected health information to be made available in print and other accessible media. These print-accessibility mandates, combined with the increasing number of persons who are elderly and visually impaired and the greater risk of being ill or hospitalized because of adverse medication outcomes (Lombardi & Kennicutt, 2001), make it important to determine what, if any, accessibility issues exist for this population. The survey reported here addressed how often, and using what methods, persons who are visually impaired access or independently read the labels on their prescription medications. METHODOLOGY Participants We randomly sampled 1,000 eligible participants in one northeastern U.S. state from a mailing list of 1,900 persons who received services from a blindness rehabilitation agency and were aged 55 and older. The agency mailed the surveys to eligible participants, who then returned completed surveys directly to the researcher to preserve the participants' anonymity. The final sample we analyzed consisted of 283 respondents; 290 surveys were returned (for a response rate 29%), but 7 were excluded because of missing data. Survey procedure We conducted a review of the literature and consulted four experts, who were current researchers and university instructors in the field of blindness, to design and assess the content validity of the survey instrument. In addition to the standard mailed format, the survey instrument was made available in braille, large print, and electronic formats and was sent to the participants in the format that they reported to prefer. MEASURES The survey tool contained two questions pertaining to the types of methods that the participants used to read their prescription medication labels. The participants were asked, When you pick up a new prescription medication, what best describes the way you read the information on the label of the prescription bottle? The participants could choose only one method in answering this question. The participants were then asked, Think of the times you took a prescription medication in the past month. What percentage of time did you use each of the following methods to read your prescription medication labels? …

Reporting demographic characteristics about people with vision loss is challenging because inconsistent measuring criteria or varying definitions are used by different surveys that collect demographic data to identify people with vision loss. The resulting information varies widely, just as does the terminology the surveys use to identify people with visual impairments. For example, commonly used terms to identify people with vision loss include legal blindness, total blindness, blindness, visual impairment, low vision, functional limitation in seeing, and severe limitation in seeing. Within these terms there are also degrees of vision loss that can affect how surveys identify visually impaired people. DEFINITIONS DETERMINE EVERYTHING Because there is not one definitive statistic from a single source that accounts for everyone with vision loss in the United States, it is important that those seeking information about vision loss, as well as those providing answers, first understand that there are several definitions of vision loss to choose from among the various national household surveys. Whenever questions about demographic statistics about people with visual impairment or blindness come to the American Foundation for the Blind (AFB), the first step in answering such questions is to understand precisely which group of visually impaired people the questioner is interested in. The answer to this question determines whether the response offers statistics on the number of people with blindness, severe visual impairment, or low vision. The surveys that track people with vision loss in the United States define visual impairment in the following ways. The most recent National Health Interview Survey (NHIS), published in 2008, defines individuals with vision loss as those who reported that they have trouble seeing, even when wearing eyeglasses or contact lenses. Included in this broad definition are individuals who reported that they are blind or unable to see at all, and no visual acuity cutoff is provided. The 1994-1995 National Health Interview Survey on Disability (NHIS-D) defines individuals who are legally blind as those who reported that they have a central visual acuity of 20/200 or less in the better eye with the best possible correction or a visual field of 20 degrees or less. The definition used by NHIS-D is unique, because there has not been another national survey that explicitly assessed the number of Americans who are legally blind since NHIS-D was conducted in the mid-1990s. …

The joy is in the journey. We all know that, but how often do any of us have the time to reflect on our careers in this wonderful field of ours? Well, the American Foundation for the Blind (AFB), where I have worked since 1972--some 36 years--has asked me to do just that. The long journey of my professional career began, appropriately enough, with a weeklong road trip across the United States from New York to San Francisco. The year was 1963, and I had just completed my undergraduate studies in music education. I could not be certified to teach in California until I took a course in the state's history. Off I went to San Francisco State University for a night course and ended up staying until I earned a master's degree in creative arts with emphasis on voice and keyboard. Meanwhile, I became certified to teach elementary school, which I did in Oakland. Because of a requirement for my degree, I learned music braille and wrote about it for my master's thesis. Little did I know that some day I would be chair of the Braille Authority of North America at a time when the final revision of the International Braille Music Code would be reviewed and passed! THE MORE THINGS CHANGE, THE MORE THEY STAY THE SAME I continue to be amazed by how much I have learned and changed, as the ideas of the field have changed, over the years. For instance, in the early days of my career there was a strong belief that a teacher of a blind or partially child had to determine as early as possible whether a student was a print or braille reader. The idea that a student could learn both print and braille at the same time was heresy. It was a given that everything in print had to be reproduced exactly in braille. Although the method I used wasn't widely practiced at the time, I taught every one of my students who were blind to sign their names in block writing, using the braille cell as a guide to making each letter. You could certainly pick the signatures of my blind students out in a crowd, because their handwriting was all the same. Raised-line drawings were considered useless, especially for congenitally blind children, and the use of raised-line coloring books was completely out! Verbalism was a hot topic. The accepted belief at the time was that one should never assume that a visual description articulated by a child who is blind reflected intrinsic knowledge of the concept the blind child was describing. Perhaps it is true that a blind child's visual descriptions are more an imitation of the world's descriptions. By the old model, however, even Helen Keller would have been supposedly uninformed about the things she described. So much for the importance of assimilation into the sighted world! For many decades, it was believed that only orientation and mobility (O&M) instructors were acceptable, even though there were wonderful teachers at the time who were visually impaired. The practice of excluding visually impaired people from training as O&M specialists changed, like so many others, in the course of my career. Be the change you wish to see in the world. --Ghandi FINDING A HOME IN THE BLINDNESS FIELD After working as an itinerant teacher in Daly City, California, I returned to the east coast, to Princeton, New Jersey, to marry and teach at the New Jersey Commission for the Blind. Georgie Lee Abel, who was then part of the education faculty at San Francisco State, had given my name to Josephine Taylor, then director of the New Jersey Commission for the Blind, as someone with potential, and Jo Taylor hired me. I had found my new family. By 1972, I had completed all but the dissertation for my doctorate coursework at Teachers College, Columbia University, and was just starting at AFB. My dissertation, on defining competencies for university personnel preparation programs in the field of blindness, turned out to be a springboard for much of my future work. …

Provision of Orientation and Mobility Services in 1990, by Mark Uslan, published in the May 1983 issue of the Journal of Visual Impairment & Blindness, Volume 77, Number 5, pp. 213-215. Mark Uslan, the author of the article highlighted in this essay, was my instructor in the Peripatology Program at Boston College in 1978-79. Reading his article for the first time, I was stuck by the changing demographics of and the projected increase in the population of people with blindness and visual impairment that I, as a new orientation and mobility (O&M) specialist, was beginning to teach. My education at Boston College and my first-hand experience as an O&M specialist during the time that this article was written gave me insight into the population that was the focus of Mr. Uslan's article. personnel preparation program at Boston College prepared me to teach O&M to people with low vision and multiple handicaps. As a student teacher at the Carroll Center for the Blind in Newton, Massachusetts, and later as an intern at the Ohio State School for the Blind (OSSB), I gained considerable practical knowledge on how to work with young blind adults with diabetes and children with visual impairments. For example, when I was assigned at OSSB to teach a young lady who was deaf-blind and fluent in American Sign Language (ASL), it was difficult to work with her effectively since I did not know ASL and did not have an interpreter. OSSB provided me with a wonderful mentor, and I learned how to communicate with the student. These experiences led to my teaching O&M for the Columbus Public School system in Ohio, and then at the Vision Center of Central Ohio, an adult rehabilitation center for people with visual impairments. In addition to providing information on the population with whom I was working, the descriptions in Mr. Uslan's article on the growing numbers of older adults with visual impairments and their need for rehabilitation services, including O&M training, were instrumental in establishing a focus for my doctoral studies. My dissertation was entitled, The Effects of Rehabilitation Training of Visually Impaired Older Adults on Self-efficacy, Depression, Activities of Daily Living, Attitudes about Blindness, and Social Support Networks. Upon completing my doctorate, I was hired as a regional consultant in aging for the southeastern United States by the American Foundation for the Blind (AFB), the organization for whom Mr. Uslan worked at the time the article was published and still works for today. This article highlighted the economic times of the mid-1980s, the shortage of O&M specialists, and the increasing numbers of legally blind people, including young children under age 5 and people over age 65. Mr. Uslan discussed the need for an adequate number of O&M specialists to be trained to teach these legally blind individuals, and he charged agencies and schools for the blind with the responsibility of meeting their students' needs in the area of O&M. Twenty-five years after this article was written, these issues are still a concern of the field of visual impairment and blindness. …

As I look back at the 50-plus years I have spent in my profession, and as I look at its current and potential future leaders, I am filled with pride as I remember past accomplishments and as I consider its strong and dynamic future. Recently, I began a list of the four great accomplishments of educators in the field of visual impairment and blindness over the last half of the 20th century. The list soon expanded to seven, and it is these accomplishments that I would like to discuss in this essay. SEVEN GREAT ACCOMPLISHMENTS OF EDUCATORS IN THE FIELD Professionalization of teaching students with visual impairments The first great accomplishment is that teaching students with visual impairments has become a profession. In the not-too-distant past, teaching and working with visually impaired students and adults was considered a folk art. There was very little writing on the education of visually impaired students. Only two methods books were available to me when I first started teaching: Education and Health of the Partially Seeing Child, by Winifred Hathaway (1994), and The Blind Child and His Reading, by Kathryn Maxfield (1928). Today, thanks largely to the commitment of the American Foundation for the Blind (AFB), we have many excellent, state-of-the-art books. There was almost no research being conducted in the field 50 years ago. Today, we have many outstanding researchers. We no longer pass along information and techniques verbally from one generation of teachers to the next, as happened when I first started to teach. Today, we are a profession, and we can stand tall and proud of the status we have worked so hard to achieve. Professionalization of O&M The second major accomplishment is that O&M instruction has also became a profession. In the 1950s, individuals in the field heard about those working with blinded veterans at the Hines Veterans Hospital in Chicago, Illinois. But it was not until Boston College established the first formal, university-based O&M personnel preparation program in 1960 that O&M began to achieve professional status. In less than 50 years, O&M has significantly changed the educational lives of visually impaired children, largely because the professionals of this field were eager to look at the O&M needs of all children and adults with vision loss. Education of children with multiple disabilities The third significant accomplishment is that the education of visually impaired children with additional disabilities became our responsibility. Long before PL 94-142 (the Education for All Handicapped Children Act) was passed in 1975, many teachers of visually impaired students were working with children with complex additional disabilities. We did not do this because it was required by law--we did it because it was the right thing to do. Recognition of low vision Thanks to the research of Natalie Barraga, our fourth major accomplishment occurred when we recognized that many legally blind children, in reality, had low vision. After Dr. Barraga taught us that these children had usable vision, over the course of a few years, in the early 1960s, many children with low vision who were learning to read braille were switched to reading print. For a while, the utilization of vision among low vision students may have been embraced to an extreme as we desperately tried to help these children learn to read. But, as a profession, we continued to study and research how best to serve low vision children, and the current status of the education of these children is excellent and continually improving. Expansion of personnel preparation Personnel preparation of teachers of visually impaired children has grown, invented, and re-invented itself since the middle of the 20th century, and this growth is our fifth major accomplishment. When I decided to become a teacher of the visually impaired, I had six choices of universities, and two of them had part-time programs in my area of study. …

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