Low vision can be extremely useful and can provide information that a person cannot get in any other way. In order to make the best use of it, cBesides learning how to use their vision, children may also need to learn to work with low vision aids, which can help them to see things more clearly or from a greater distance. Examples include closed-circuit televisions
(CCTVs), monocular and bioptic telescopes, and colored filters which enhance contrast or reduce glare.
On the other hand, with limited time in the school day, is it wise to spend time teaching children to use their vision? Would that time be better spent teaching them “blindness skills?”
Is Vision Stimulation Useful?
Opinions regarding the effectiveness and importance of these exercises vary. Naturally, parents and teachers want children to be able to use their vision to the fullest extent possible. Some adults with low vision feel that the emphasis on the teaching of visual efficiency skills communicates to the child that it is better to see, even a little bit, than to be blind. They report that they spent much of their childhoods “passing,” or pretending to see things because parents or teachers wanted them to see.
For one mother of a child with retinopathy of prematurity, these reports hit very close to home. Her daughter began learning both print and braille when she was six years old. “She uses her vision better than she would if she hadn’t had the training, but she has to hold things inches from her face to read them.” Her daughter also complains of eye strain headaches after a short period of visual reading and after being examined in the doctor’s office. “I feel like they’re happy because she can see such small print, even though it hurts her or she’s just two or three inches away from it.”
Other parents have had more positive experiences with visual skills training. Kathryn, a parent from Maryland, worked with her daughter’s teacher to identify things which were interesting to her daughter and to design a play area which provided high contrast. She also hung strings of Christmas lights in her daughter’s room to encourage visual attention. Her daughter has since lost much of her vision, but Kathryn feels that the early stimulation was helpful in some ways.
Missy, the mother of a four-year-old daughter who is learning print and braille, found that drawing her daughter’s attention to visual stimuli was helpful.
Videos figured prominently into my daughter’s infancy and toddlerhood. Like using the computer and reading books, watching videos was something we did WITH her. They provided a way to stimulate vision, helping her to track and focus; a means of exposing her to shapes, letters, and patterns she may not notice in other contexts; and a way to help her make connections between real objects and more abstract depictions of them. Also, they could be paused to point out specific details, and they could be viewed over and over again.
Besides helping the child learn to use his/her vision effectively, vision stimulation games can help motivate the child to explore and learn about other concepts as well. Andrea Story, a teacher of infants and toddlers with visual impairments from Alaska, related such a story in response to some of Missy’s comments.
One child I worked with was having trouble understanding containers. He wasn’t figuring out that he should/could reach in and explore. What did the trick was a clear plastic jar (I think it was a mayonnaise jar) with a penlight inside. He loved lights and when he saw the light shining in the jar he went crazy to explore and find a way to get it. He began to explore containers differently after that. Nothing else had motivated him to explore this way–and he figured it out all by himself once I found the way to motivate him.
Maximizing the Benefits of Vision Stimulation
Visual stimulation seems to be most useful during infancy and very early childhood. Authors agree that it may be more helpful to children with certain causes of blindness than for other children. Pairing the visual stimulation with other experiences is also helpful. Missy expressed this in an informal discussion with other parents whose children had the same eye condition which caused her daughter’s visual impairment:
As much as I would like to take credit for my daughter’s increase in visual acuity, I think it was mostly physiological(?). What she and I can take credit for, however, is how nicely she uses the vision she does have. And that is probably due to “vision stimulation,” which I take to mean creating visual experiences for the visually impaired child; adapting and enhancing materials and the environment to make them more appealing to the visually impaired child; and incorporating other senses (touch, hearing, and smell) into visual experiences to help her make better sense of the sketchy visual image.
It was very clear that she simply could not see many things as an infant. We paid close attention to what did seem to interest her visually, and took it from there. For example, she did not appear to perceive a red circle on a piece of paper, but she could see a red translucent circle on the light box. The circle on the light box was not only interesting to see, but it could also be picked up and mouthed, thus reinforcing “circle-ness” through touch in addition to vision. The more experiences she had with the circles she could see, the more this seemed to help her find and understand circles that weren’t so easy for her to see. Some time after we began playing with shapes on the light box, I was wandering around the toy area of Wal-Mart, pushing her in the cart. I stopped for a few moments to look at an item. I almost fainted when I looked up to find her intently focused on a package at her eye level that depicted a bright round sun against a dark background. Usually not very verbal at that time, she proclaimed, “KIRKLE”!
Playing with shapes on the light box (“vision stimulation”) not only helped her understand shapes, labeling, sameness, difference, etc. . .but by making some things fun to see, it motivated her to use her vision in those settings where it might be more difficult to see. The ultimate goal is to motivate the child to make the best use of the vision she has and to identify those situations when the use of another sense would be more efficient. As it looks now, she might use her vision to read a street sign but her sense of touch to read a novel. She may write a grocery list with a felt-tip pen but take notes in class with a Braille ‘n Speak.
Avoiding the Negative Effects of Vision Stimulation
Ferrell and Muir point out a number of negative aspects of vision stimulation in their 1996 article. These include the use of unusual objects to elicit a child’s attention; interpretation of behaviors which should indicate boredom as lack of cooperation; abandonment of education in other necessary skills; and damage to the self-esteem of the child and family. Overemphasis on the use of small amounts of vision may result in ongoing efforts to please parents and teachers by appearing to see. (Ianuzzi, 1999) Unfortunately, the child is hurt most by the facade. Jody Ianuzzi graduated with a third-grade reading level. Unhappy about the lack of opportunities available to her because of her low literacy, she taught herself braille as an adult.
Missy tried hard to avoid conveying a negative attitude about blindness to her daughter.
“‘… If’ and ‘how much’ she sees is completely beyond her control and therefore never the subject of praise by us. Although it is sometimes difficult for us sighted people, we try to avoid conveying to her a sense of excitement when she appears to see something we thought she could not see. And, of course, we try to never convey any disappointment when it is clear she cannot see something. What we call “vision stimulation” should only be “play” to her and thus fun, relaxed and enjoyable for all of us.
Missy’s thoughts reflect the attitudes of my own parents. Perhaps this was one reason why I was never bothered by admitting that I couldn’t see something … why I never felt, as many people with low vision do, that I needed to see anything in order to please people. What I saw I saw, and what I didn’t no one could make me see.
Authors readily acknowledge the benefits vision stimulation and visual efficiency skills training offer some children. (Ferrell and Muir, 1996; Levack, 1993; Willoughby and Duffy, 1989) From the experiences of parents like Missy, it appears to be very useful. However, as the experiences of Debbie’s daughter and adults like Jody Ianuzzi show, there is a point when the emphasis should shift to other techniques and instruction in the use of vision should be limited to situations when using it is truly helpful. The environment should be designed so that use of vision is practical, and instruction in the use of vision should be included as part of instruction in other tasks rather than as an individual component of a program. (Ferrell and Muir, 1996)
Ferrell, K. A.; Muir, D. W. (1996). A call to end vision stimulation training. Journal of visual impairment & blindness;90(5), 364-366.
Ianuzzi, J. (1999). The danger of passing. The braille monitor.
Levack, N. (1993). Low vision: A resource guide with adaptations for students. Austin, TX: Texas School for the Blind and Visually Impaired.
Willoughby, D.; Duffy, S. L. M. (1989). Handbook for itinerant and resource teachers of blind and visually impaired students. Baltimore: National Federation of the Blind.