There is no easy case of multi-handicap whether or not visual impairment is also involved. We have allowed ourselves to fall into the trap of thinking that the policy of 'Care in the Community', because it is so obviously right, must be very simple to implement. But is that so? With commendable bravura the Principality declared an All Wales Strategy in 1983 to carry out the policy which government had set us all 10 years to realise and now, three years later, we have become aware that the policy's implementation requires much more planning than it has been given. Moreover, it cannot — in the interests of those it is intended to serve — be allowed to develop in an unorganised variety of ways: it is not enough to say community care (rather than hospital care) is the policy, get on with it.
In the past hospitals for the mentally handicapped gathered together in places of isolation people who had, for one reason or another (by no means always a valid one), been rejected by the community: in most respects this presented a single coherent problem. Whatever variations on the theme might have been required to take account of individual cases, the theme was one and the same. But with 'Care in the Community' there can be as many themes as there are individuals and each one will need the professional services of a trained group of workers. Therefore, ideally, there should be as many ways of community care as there are individuals needing it; but this is not an ideal world. Nor will any good be achieved by pretending that it is, for we cannot afford to plan in ideal terms. A limited number of strategies must be worked out nationally to provide for what is affordable locally, in order to ensure that 'Care in the Community' is available for everyone who needs it. We have a particular concern to see that, within those national strategies, the needs of multi-handicapped visually impaired children and adults are not overlooked.
The question 'Can the Community Care?' is too often thought to ask whether it is any longer in the nature of the community to care. Problems of a caring community do not arise, we are assured, in areas where an extended family system copes with individual cases of mental, physical or sensory disorder. The welfare state, established after the end of the war in 1945, sought to take account of the fact that an extended family system no longer applied, even in the most diluted good-neighbourly form, in the United Kingdom. The framework of asylums and voluntary bodies, set up to satisfy Victorian values, behind which problem cases were concealed, was used to help to implement Lord Beveridge's proposals. A clarity of conscience was ensured: the handicapped were being looked after in hospitals and the National Health Service would take good care of them there.
But handicap is not illness: it requires social awareness rather than medical care. The community has now been asked to have another look at its conscience. It has been given 10 years in which to put things right: albeit no suggestions have been offered as to how this might be done. Moreover, although the policy has been changed, the old mould has not broken.
Not only have no suggestions been made as to how the community might care but in addition no training has been introduced to enable it to do so. Particular reference to our own field shows the strength of the two generalizations that have just been made.
How do multi-handicapped visually impaired people fit in to the proposed scheme of things? The latest (1986) government statistics admit that there are 18,809 such people. This is certainly an under-estimate, as many multi-handicapped visually impaired people are not registered as blind or partially sighted. Looked at another way the incidence of registered blindness is 6% to 8% more likely amongst people who have mental handicaps than amongst people who do not; the total has not been calculated but it would certainly be in excess of the present 'guess-timate'. What we can be sure of is that specialist care is at present provided within the community for only a single figure percentage of the total number of people who might expect it. One attempt to ensure such care in the future has been thwarted by the fact that the individuals involved have been chosen because of their visual problems but without reference to the degree of their mental problems — so that although their visual impairments need cause no delay in their progress into the community, their mental handicaps will do so. The authorities, with the best will in the world but with inadequate regard to the facts, have got their priorities wrong. Even when no mental handicap is involved the same clinical assessment of vision can allow of different performances by individuals. Some will do better than others. Varying degrees of mental handicap are bound to affect individual performance to an extent that visual impairment alone will not.
The All Wales Strategy has calculated that ten years after the start of the move into the community, services based there will cost 7% more than the former hospital based services. It has also been commented that in the event of a former hospital resident having sight problems there is always a specialist worker for the visually impaired in the community who will be able to help with them. Can the extra money be found? Do the specialist workers exist?
Back to the ContentsOpen Forum, 4 June 1986
Summary prepared by Monique Raffray
The forum consisted of three talks on rehabilitation followed by discussion. The subject was considered from three points of view. medical and psychological; social service provision; and consumer approach.
D.L. McLellan, Professor of Rehabilitation, University of Southampton, Hampshire In medical terms, rehabilitation may be described as the active process through which, physically, psychologically and socially, former capacities are restored either completely or at least to their maximum potential. The word 'active' is an indication of the amount of work and effort required.
The psychological aspects, which even today are perhaps not always sufficiently stressed, include learning how to cope with the attitudes of some non-disabled people and how to alter and adapt one's self image, expectations and role. Adjustment also means discovering how to make the best of every remaining asset:
what tests the end results of rehabilitation is the way of life achieved. While some may be able to work their way through this whole process unaided, in many cases it cannot just be left to happen on its own.
Medical text books are usually written entirely from the doctor's point of view; they rarely enter into what it feels like to have a disease and what non-medical problems and difficulties it may involve. The focus is on diagnosis and treatment. Now, however, it is being increasingly recognised that more than this is needed. With stroke patients, for example, not enough is always done to provide the psychological help which is quite as important as physical assistance; adequate explanations are often not given and the positive qualities of a patient may be disregarded instead of being taken into account and used to the full. There is not enough communication and co-ordination among the workers involved to enable each of them to understand the patient as a whole person. Skilled handling of a rehabilitation team is essential; precise goals should be aimed at and the family circle drawn in as much as possible.
But even when conditions are good the disabled
person sometimes feels that all the admirable organisation which
surrounds him is not what he really wants. He would much prefer
to make his own decisions and contact for himself the people and
places whose help he may need. He would like to have a budget
which he could spend himself for this purpose. Such an approach
is being adopted in certain parts of the country, probably on an
experimental level.
However, those who are able to benefit from this kind of automony must not ditch the less able disabled who could not possibly manage this, sometimes as a result of the very nature of their handicap. People must be able to make their own choices and the varied patterns and field of disability be catered for. Resident units, for instance, will not suit everyone but must not be arbitrarily dismissed as always bad.
Perhaps the biggest changes needed are not so much in medical provision as in what social services and local authorities have to offer; and here disabled people themselves can form the most effective pressure groups.
One good idea which is being tried out in North Hampshire is that there should be a key worker chosen by disabled people themselves who would be able to contact the various appropriate organisations on behalf of those who cannot be their own advocates. This should also bring closer co-operation between all those concerned.
Vincent Oliver, Principal Officer, Social Work Services for the Disabled, Hampshire County Council The term rehabilitation can be viewed on different levels, depending upon the standpoint of the individual. What may be seen as rehabilitation by the handicapped person may not be viewed in the same light by the social worker or the rehabilitation officer; and perhaps it should not be. It is a term open to wide interpretation, so let us consider one particular example, rehabilitation of visually handicapped people in Hampshire. The population of the county, amounting to about 1.5 million, of whom 17% are of pensionable age, is a wide mix including the navy and army centres, the larger conurbations of Southampton, Portsmouth and Basingstoke, and those living in the retirement areas along the coast in the South West of the county. Of this population 5395 are registered as blind or partially sighted, of whom 4510 are at least 60 years old.
The initial contact with the visually handicapped client is made by a visit from one of the members of the area office to offer registration and this first visit is usually undertaken by an unqualified social services officer. This does not necessarily imply poor service, because these
workers often develop a high level of knowledge and expertise about this particular client group. It is anticipated that Hampshire policy may be to encourage general awareness of the problems of visual handicap in all social workers with the back up of one nominated worker in each area office with specialist interests and skills. All social workers therefore should be able to carry out a registration visit if necessary. This visit should include general assessment, a tentative gauging of the stage of adjustment reached to sight loss, and the provision of information as to what is available in services and benefits. (The County has produced a guide to services.) The client must be given the opportunity to talk about his/her reaction; and this in fact may well require more than one visit.
Since 1982 the Hampshire Social Services Department has adopted the policy of employing rehabilitation officers for the visually handicapped, who have the dual role of mobility and technical officer. At the initial stage the rehabilitation officer has to take into account that there may well be a difference between the clinical BD8 measurement of a client's sight and his functional vision. He has to ensure that residual vision is being used to the full and to look at each client as an individual so as to be able to offer not a set pattern of training but whatever is appropriate in each particular case. There must then of course be constant monitoring and adjustment.
Mobility training ranges from training in basic indoor mobility, which should be introduced at the outset, to outdoor travelling skills at whatever level is suitable. Sighted guiding skills are offered to family and friends.
Safe cooking is the aspect of daily living skills most frequently asked for, and here again it is important to involve family or friends who may otherwise block the client's progress by over-protection. The communication skills offered range from the use of a pension book signature guide to tuition in braille; but among these skills the use of handwriting aids and the telephone, and tuition in typing are the subjects most in demand. Some of the communication training is organised through classes. This often involves enlisting the co-operation of volunteers:
in encouraging clients to make good use of their leisure time, rehabilitation officers also have close links with voluntary organisations.
Hampshire has a small residential rehabilitation unit in Lymington. This unit takes three clients, for a residential course of three weeks, three times a year. It has also been used as an assessment centre for less intellectually able visually handicapped young people. Re-habilitees learn through experience and are responsible for the maintenance of their own rooms in a self-contained flat, with shared domestic facilities.
There are a number of issues which create problems
when services are being planned. The tack of counselling provided
by area office social work teams means that clients are often in
need of counselling by the rehabilitation team before
any effective training can begin. Should such counselling in fact be part of the rehabilitation officer's role? Moreover, there are too few rehabilitation staff and too many clients. Ideally there should be one rehabilitation officer for each area office — that is seventeen rehabilitation officers instead of the present six. Perhaps every visually handicapped person would benefit from at least one visit from a rehabilitation officer even if it is only because of the hints and tips which can make life so much easier.
Finally, there is the difficulty of obtaining good qualified staff. In view of this it is essential that the training available should be as comprehensive as possible to enable staff to cope with the very wide range of demands made upon them.
Fred Reid, Vice-Chairman, Vocational and Social Services Committee, RNIB
All blind people do not think that they are necessarily always the best judges of every aspect of the rehabilitation services delivered to them — and Fred Reid sees himself as one of this group. They are one of the voices which should be heard and their contribution should be to act as an intelligent pressure group advocating developments and improvements through sensible dialogue with providers of services, from politicians to workers in the field.
One of the most important things brought out by Professor McLellan was that the rehabilitation of the physically handicapped is rooted in medical practice and takes place to a considerable extent within the structure of the National Health Service; whereas in the case of the visually handicapped, rehabilitation takes place outside the context of the health service. There may be good historical reasons for this but it has severe consequences: it produces a gulf between the services which are delivered to the visually handicapped outside the hospital and the medical services provided for the physically handicapped within the hospital. Only in a few instances, Moorfields is one of them, is there any attempt to deliver social work services to the visually handicapped before they leave hospital and while they are still going through the process of having to admit to themselves that they will have to live with a long term handicap. Yet it is of crucial importance that counselling and rehabilitation should begin at this early stage, and that bridges should be built between local authorities and the health service.
The disabled do not feel that they are ill;
but they do need to be helped in encountering and overcoming the problems that come not from within themselves but from the structure of the society outside. The almost educational role which the social services often fulfil can be exciting and constructive. Blindness can bring opportunities for acquiring new skills and discovering new potential in oneself. We should not become too gloomy about the traumatic problems of handicap as they appear from with-
out; the handicapped person himself may have the capacity to see the situation in a different and more positive way.
It is important to strike the right balance between providing money and providing services. Money can never be a complete answer: the fight for disability allowances must continue, but it is difficult to imagine any allowance that would ever be large enough to enable the visually handicapped person to purchase for himself all the aids and services he requires.
Vincent Oliver's talk highlighted the problem of the considerable differences in provision and standards across the country; and one of the most alarming aspects of this situation is that it makes it difficult to know what standards and practice ought to be adopted. Definitions are impossible at present because the conditions are so fluid — we are still learning about what visual handicap involves, what its problems are, and how they should be approached.
There is a need for interaction between bodies like the RNIB and the Regional Associations on the one hand, and the local authorities on the other, to work towards a minimum standard of provision and services, while taking into account differences in local conditions. One other disturbing fact in the present situation is that the local authorities who deliver the best services tend to improve further, while those whose services are most unsatisfactory appear likely to get worse.
There is abundant evidence that most of
the registered and unregistered blind are elderly and that this trend will have increased by the end of the century; so we should be thinking strongly and definitely in terms of a service that in the main will have to be delivered to people who are confronting age.
Some argue that those who have reached a certain age have had their lives and the chance to enjoy themselves, and should be content to slip quietly into the grave and not annoy anybody. Perhaps such an attitude reflects the views of the community at large; or perhaps it has arisen because correctives to such prejudices have not been built in to training, or again because other demands on social service personnel draw their attention away from the elderly. In any case this is a challenge we must meet. As Vincent Oliver pointed out in connection with mental illness, it is important to remember that rehabilitation work with some visually handicapped elderly people may be hampered because they have other more severe disabilities due to ageing. The serious problem here is that whether blind or sighted, one's chances of getting proper geriatric care are minimal. Unless we can distinguish between the rehabilitation delivered by the social services and the care provided by the health service, we may well find that there is not much we can do for those who are suffering from ageing, as opposed to those who are merely old but quite able to benefit from many of the rehabilitation opportunities outlined by Vincent Oliver.
Back to the Contentsby W.D. Alan Beggs
Blind Mobility Research Unit, University of Nottingham
By means of qualitative and quantitative surveys, a picture of the working life of a mobility officer (MO) in local authority employment was built up. Two major but related aspects are described. First, the diversity of the visually impaired population seeking mobility training, and second, the way in which MOs have been able to 'tune' the long cane package to suit the many low vision clients they meet. In addition, some of the enduring problems faced by MOs will be discussed.
At the Blind Mobility Research Unit, we have begun a broadly-based programme of research into many aspects of the mobility of the low vision clients. Some of this research is descriptive, some is prescriptive, and some is experimental. Our hope is that such an approach, developing in close co-operation with grassroots expertise on training the low vision client, may in time lead to new insights and a more soundly based professional attitude towards, and competence in, training low vision mobility.
The need to focus on the problems of the low vision client was recognised in the USA some time ago, and a number of attempts have been made to get to grips with the theoretical and practical problems. Typically, these have been either atomistic, analytical approaches to the problem (Apple and May, 1970; Hughes, 1967; Vigorosa, 1970); or untested suggestions about how clients might be trained (e.g. Hennessey, 1975). Recent articles and correspondence in this journal have also attested to the growing interest in this topic. A suggestion has even been made that experienced MOs have developed their own expertise in the field of dealing with the problems of the low vision client (Klemz, 1982, 1984); but this too is an as yet untested claim and might be related more to the "mythology of professionalism" (McKinley, 1973) than to reality.
Our initial feeling was that we needed to find out exactly what the range of current practices really was. We have tackled this in the most obvious way by talking to MOs about their work and their attitudes to it. The theoretical approach which has informed this work is that of Expert Systems (Wellbank, 1983). This is a relatively new field whose focus is the elicitation of knowledge from experts, such as medical consultants and engineers. This expert knowledge is, of course, scarce and valuable. Once it has been elicited, however, it can be made public and even simulated on a computer diagnostic system.
This reasearch has two initial goals. First, a description of the way an MO may 'tune' the training package to suit the low vision client:
second, a focus on the form or style of current
mobility training. The first of these will be discussed in this
paper, with the second being addressed in a subsequent article in
this journal.
In each article the female gender will be ascribed to the MO and the male gender to the client. This is merely to avoid unnecessary confusion and does not reflect any bias.
Methodology
In order to orientate ourselves initially, we first conducted a postal survey of a 10% sample of working MOs and did some pilot interviews. From these it proved possible to identify a number of areas which MOs themselves considered to be important. Interestingly enough, these same points were discussed by Welsh (1979).
On the basis of the results from these initial investigations a semi-structured depth interview schedule was constructed. This method is used in situations where it is important to elicit more than factual information from the interviewee, as is the case in clinical practice (Meehl, 1951; Bertaux, 1981; Plummer, 1983) or market research (Green and Tull, 1978). Its disadvantage is that the information is subjective and qualitative, and it is therefore desirable to augment it. Insofar as quantifiable data from MOs' records were available these were used as a secondary check on what they said. We then followed up the work by a third stage; respondents were given the opportunity to comment on an initial draft of the report on which this paper is based.
We sampled the whole range of experience from those MOs who had just qualified to those who had been in post since the beginnings of the MO service in the UK (1967). Fifteen MOs were interviewed, representing at least 11% of the MOs in posts directly or closely associated with mobility training in England at that time.
As a further check on the largely qualitative results from the first phase of the research, we undertook a comprehensive postal survey in order to quantify certain data such as working patterns, types of client and methods of training. We are greatly indebted to the NMC for its help in circulating all NMC-trained MOs. The response rate was unfortunately rather low at 26%, a total of 50 replies from active MOs. These replies were from MOs working in 24 local authorities in England, Scotland and Wales (70%), in schools (20%), and in residential rehabilitation centres (10%). These percentages
correspond quite well with the way in which MOs are distributed across these three areas of employment (77%, 18% and 4% respectively). The low response rate could be taken as confirmation of the pressure of work and rather limited record-keeping systems which our respondents described, rather than as apathy.
The client population
It would be true to say that the first year of most MOs' professional life was — and still is — very difficult, often because of some naivety on the part of both the MO and the employing social services department. This problem was explored in more depth by Beggs (1985). Apart from discovering how to integrate herself with the team already at work, the new MO also has to cope with a deluge of unexpected difficulties concerned with client training and assessment. Part of the problem lies with the wide range of clients seen by MOs. These were said to range from the young, fit and totally blind, who tended to be in the minority, to many with multiple handicaps, sensory, physical and psychological. While those MOs in voluntary agencies said they tended to see younger clients, most local authority MOs saw clients whom they described as elderly, infirm, under-motivated and with some residual vision.
The postal survey enabled us to quantify these descriptions of the client population. Although local authority MOs saw some clients as young as 8 years, they also saw some as old as 90. The average age of clients was 50 years, but the distribution was markedly skewed towards the elderly. A total of 37% of clients were over 60, with the most frequent ages between 60 and 70. The number of clients seen in a year averaged 11, but varied from as few as 7 to as many as 23. In residential settings the average number of clients seen was higher at about 22, with the range very much smaller. There is little doubt that the differences in these patterns of work reflect differences in working conditions;
driving to rural visits is said to take up a great deal of the time of the MO who is operating alone in a county; and many local authority MOs have other responsibilities besides teaching mobility. Further research is needed to quantify the extent to which MOs spend their time on non-mobility tasks.
Only between about one fifth and a quarter of all
clients seen by local authority MOs present conditions which are
usually associated with total loss of visual function, figures
confirmed by the data on visual status. It was also fairly common
for MOs to report on clients who had more than one visual problem
— about one in nine could not be simply classified, and
many had additional physical or sensory handicaps. The sort of
client population met by the typical local authority MO is thus
very heterogeneous, in respect of age, aetiology and additional
handicap. This population contrasts strongly with the very
specific group for whom the long-cane system was originally
developed, namely
the young, fit and highly motivated. Accordingly, it falls upon the shoulders of the novice MO to adapt the training package in the best way she can, and as quickly as she can.
Adapting the training package
Not surprisingly, novice MOs found it very difficult to decide what sort of rehabilitation programme to implement, because they lacked both effective assessment skills and the knowledge to develop a training schedule with useful and relevant mobility skills for individual client needs. At the beginning of her career an MO is best equipped to train totally blind clients to use the long cane; and the implicit assumption is that the client will need all the skills in the training package. The reality is very different. The first year of an MO's working life is spent making the adjustments needed. During this time she may get some help from other MOs and from her reading; but to a large extent her own inventiveness and experience are involved. Many MOs said that they had mercilessly plagiarised any successful strategies used by their self-taught clients. There was very widespread concern expressed within the profession about this initial level of unprepared-ness for the 'real world'. However, by the end of this trying period MOs had made some quite dramatic changes to the size and content of the package they had themselves been taught and had expected to teach.
The first major change concerns the amount of training which is acceptable to, or needed by, a given client. Apart from those clients with useful vision for whom the long cane is inappropriate, there are many who are motivated to learn only very limited skills and may never need those required for advanced city centre travel. Elderly clients may need only a minimum of route-specific mobility; and clients in rural areas and villages are the norm for some MOs. This lowering of expectations was difficult to accept for novice MOs, who felt they ought to be turning out text-book travellers.
From our quantitative survey it was possible to see the extent of the variation in the length of training given to each client. The number of lessons for local authority clients varied from 1 to 150. One third of all training episodes took fewer than 10 lessons, with a further third taking between 10 and 25 lessons. Training a client to use the full long cane system would take about 35 or 40 lessons. While some of the very short training episodes are almost certainly top-up or follow-up training, the variation in the length of training suggests that MOs extend or contract the standard long cane package very considerably. This shift from a structured system of training to one of flexibly selecting relevant sub-skills for each client was perhaps the biggest change in approach made with increasing experience.
It soon became clear to MOs that apart from visual ability the major factor determining a client's mobility performance was his level of
motivation: in fact, experienced MOs claimed that this was of paramount importance. Having been led to expect that all clients wanted to become fully independently mobile, novice MOs found that they were ill-equipped to deal with clients who had low motivation. Some 'potential' clients rejected them and the skills they had to offer; this further undermined the novice MOs' self-confidence. Experienced MOs had become more sanguine about this rejection, and case-load pressure often meant that they could leave it to the clients whether or not to request mobility training.
Although experienced MOs had come to realize that the motivation to be mobile is a complex matter, affected by the social, personal and economic status of the client, it was not always easy for them to unravel these factors. Some MOs were able to use social work skills, but many had to rely on a social worker to do this for them. To be effective, an MO really needs to have a wider understanding of the psychological and social factors involved in mobility. There was wide support for more course input in this very difficult and important area.
Many MOs, especially the more experienced ones, were well aware of the problems of the 'dependent' client. Several of them spoke of 'contracts' and of ensuring that the 'MO-as-friend' relationship did not build up to the detriment of the client himself and to the inappropriate use of the MO's time. They said they would welcome information and guidance on this topic.
Conclusion
MOs perform a difficult and valuable role in the rehabilitation of blind and partially sighted people. That they can do this is due at least as much to their own resourcefulness, determination and sense of responsibility as to their current training. Unfortunately there exists no corpus of research-based knowledge which would enable the training agencies to provide adequate theoretical and practical training in how to deal with the large variety of clients whom the MO will meet (most of whom have some residual vision). Research alone can provide this sort of information and it is no reflection on training courses that they cannot as yet give the trainee MO firm guidance on this topic.
The job of the MO is essentially flexible and
involves being prepared to tackle the client's additional
physical, sensory and emotional problems, as these may prevent or
hamper what may be seen as perfect mobility. MOs are inadequately
trained in interpersonal skills, such
as assessment, counselling and teaching. Being able to understand and manage interactions and interventions would seem to be an essential part of the MO's qualifications. Already, agencies are making appropriate moves to improve the training for working with the visually impaired, and it is hoped that this research endorses the feeling that additions to the repetoire of skills needed by MOs are long overdue.
Acknowledgements
This paper was made possible only through the co-operation of those mobility officers who gave their time for interviews and questionnaire completion. I am indebted to David Clark-Carter for his help with the computerised analysis of the quantitative data. Earlier drafts of the paper were commented on by my colleagues in the Blind Mobility Research Unit, by Peter Ryan, then Principal at the National Mobility Centre, Birmingham, and by the DHSS. The BMRU is funded by the DHSS under a grant to Professor C. I. Howarth, whose direction and support are acknowledged.
References
Apple, L. and May, M. (1970), Distance vision and perceptual
training: a concept for use in mobility training of low vision
clients, New York: American Foundation for the Blind.
Beggs, W.D.A. (1985), Giving blind people access to the world,
Social Work Today, October 14th, 13-16, 18-23.
Bertaux, B. (1981), Biography and society: The life history
approach to the social sciences, Beverly Hills, Calif.: Sago.
Green, P.E. and Tull, D.S. (1978), Research for marketing
decisions, London: Prentice Hall.
Hennessey, J.A. (1975), A pragmatic approach to the orientation
and mobility needs of the low vision client. Blindness Annual,
AAWB, 1974-75, 80-88.
Hughes, P.N. (1967), Orientation and mobility for the partially
sighted, International Journal for the Education of the Blind,
16, 119-120.
Klemz, A. (1982),Trainingthe low vision client is not as difficult
as has been suggested. Paper given at the National Mobility
Centre Annual Course, Birmingham.
Klemz, A. (1984), Teaching mobility to people with low vision,
New Beacon, LXVIII, 325-328.
McKinley, J.B. (1973), On the professional regulation of change,
in P. Halmos (Ed.), Professionalisation and social change, Keele:
Sociological Review Monograph, University of Keele.
Meehl, P. (1951), Clinical versus statistical prediction: a
theoretical analysis and review of the literature, Minneapolis;
University of Minnesota.
Plummer, K. (1983), Documents of life: An introduction to the
problems and literature of the humanistic method, London:
George Alien and Unwin.
Vigorosa, H, (1970), The partially sighted client. Long Cane News, 4, 4-7.
Wellbank, M. (1983), A review of knowledge acquisition techniques for expert systems, Martlesham Heath, Ipswich:
Martlesham Consultancy Services.
Welsh, R.L. (1979), Low vision mobility: A look to the future,
Paper given at the International 0 & M Conference, Frankfurt,
dermany.
Back to the Contentsby Pauline James
Principal, National Mobility Centre, Birmingham
The author is the new Principal of the National Mobility Centre. In this article, she gives a brief outline of her own professional training and career, and argues that her experience has shaped her views of the whole process of rehabilitation and of the kind of training required for professional work with the visually impaired. She writes as a practitioner in the belief that subjective comment, if confirmed by a sufficient number of people, can be a basis for objective research and stimulus.
Training and Work Experience
My career in work with the visually impaired began in 1975 when I was seconded by the Royal National Institute for the Blind to train as a Mobility Officer at the NMC in order to work at Clifton Spinney, their residential social rehabilitation centre which has since closed. This training followed on from a course in teacher training.
At the time of my training the emphasis was still very much on the practical aspects of long cane mobility training with theoretical input mainly concentrated on immediately related topics such as mobility theory, braille, audiology, anatomy and physiology of the eye, and theories of learning and teaching. There was little or no input on broader subjects such as counselling, interviewing, recording or broader sociological or psychological issues. Mobility training was aimed at the young, fit, totally blind who were well motivated and mentally able. On one or two occasions it was suggested that the cane grip might need adjusting for an older person, but such passing comment tended to be lost in the general thrust of training. To be fair, mobility as a speciality was still in its infancy and it was seen as a priority that training should be given to the younger or more able people who would then act as good ambassadors for this still new and not totally accepted service.
The very positive aspects of the mobility training that I received were:
1. The additional insights into the problems of mobility gained by personal blindfold travel, and an accompanying confidence that the system worked. This led to greater conviction when teaching the subject to visually impaired people.
2. The ability to plan the lessons in a sequential way. In describing this lesson plan I can do no better than quote Welsh (1986); "the typical sequence not only addresses skills in a hierarchy of increasing difficulty and complexity, but it also includes a systematic increasing of the level of responsibility and problem solving that the client must assume, and it includes an increasing amount of contact with the general public".
This approach has much wider application than just
mobility training and has stood me in
good stead when used as a basis for the teaching of many rehabilitative subjects to a whole range of visually impaired people.
I completed my mobility training thinking that the world outside was full of blind people just waiting for me to deliver this special package of training which would have them up, moving and independent in no time at all. Life was not to be that simple and one has to be fair and say that no training course can provide a student with all the answers to life's problems in advance.
On arrival at Clifton Spinney, I found that my clients were not all young, mentally and physically fit and well motivated, that mobility training was not necessarily the biggest priority that they identified for themselves, and that where it was, a formal long cane programme of training was not always the required approach (for a more precise description see James, 1977). I soon discovered, however, that the long cane system of orientation and mobility could be readily adapted to suit the needs of a wide range of individuals.
Many of my clients did not want mobility training or were not ready for it and I seemed to spend a lot of time just talking to them. Was this what I was trained for? Very soon however, it became clear to me that in fact this talking was an important part of the rehabilitation process and that it could be used constructively. I was fortunate in being able to share my experiences and ideas with other more experienced members of staff and from this sharing, and through my own observations, grew the foundations of my belief in the theory of loss and counselling.
My work at Clifton Spinney gave rise to two other significant observations which influenced my philosophy and practice. Through being a member of a staff group and through observing the benefits that many clients gained from simply interacting with other visually impaired people I developed a belief in the value of group work as one appropriate method of working with blind and visually impaired people. Secondly, although there is much that can be said against residential institutions as environments in which to live or train (and Clifton Spinney had its share of disadvantages) it was clear that for some clients a residential centre was the right environment. From this experience
grew the belief, which I still hold, that service providers should offer a range of options for clients, and that access to these options should be through assessed need and suitability and not through administrative convenience.
On leaving Clifton Spinney I worked for several years as a Mobility and Rehabilitation Officer for two local authority social services departments. Here I was confronted with new and different issues. Whilst my training had prepared me well to teach mobility, it had not prepared me for the wider perspective which I needed to adopt. In the social services department I had to come to terms with policies, and committees, legislation, administrative systems and politics in a way not experienced before. I had to see the client as part of a family or wider community and to consider how this influenced my working relationship with him. I had to learn to cope with the rejection, anger, fear, apathy, despair and joy experienced by my clients and their families. I had to learn how to knock on doors (the client's and the department's); and to find out what the agency could offer in terms of a specialist service and also a generic service. I had to learn to be more of an advocate for the client and for the service. For me this was exciting and challenging and I was fortunate again to be placed where I received good support and supervision, and where additional short training courses were available.
The next logical step for me was to improve my practice by further training, particularly training which would develop my "people skills": so I was seconded by Nottinghamshire County Council to study for the Certificate of Qualification in Social Work.
Following this training I worked for two and a half years as a Senior Rehabilitation Officer in Nottingham. This post involved using management skiffs, social work skills and rehabilitation teaching skills and with my broader range of training I felt able to offer a more effective and immediate service to clients, based on assessed need and not administrative convenience.
My social work training offered a broader based theoretical foundation upon which to work. The opportunity to study in more depth specific subjects such as counselling, management, group work practice, community work, work with the elderly and handicapped, and local and central government has had direct relevance to working with the visually impaired. Larger subjects such as psychology, sociology, child care, deviance and welfare rights, have a contribution to make and I can think of no subject I studied which has not had a positive influence on the qualify of the work I subsequently carried out with visually impaired clients. The additional skill and knowledge I had acquired enabled me to offer mobility to people for whom it might not previously have been thought suitable.
Present Training
The basic programme of training at the mobility
centre has changed over the years. In
our present programmes we have some input on loss theory, counselling, interpersonal skills, local government and recording. The practical mobility programme has been refined more than many critics of the system probably realise. Personal experience and the acquisition of personal mobility skills are still important but more consideration is being given to low vision clients and low vision goggles are being used. It is planned to devote more time to teaching mobility without the use of canes. The range of teaching practice placements is increasing in order to provide broader experience.
It has been accepted that our body of knowledge about both mobility and the rehabilitation process as a whole has increased and that courses need to be adapted in the light of this new knowledge. There is however a limit to the amount of change that can be incorporated into the present structure without reducing the core so much that the course becomes ineffective.
Future Training
Mobility is one of the most important aspects of the total rehabilitation process. It requires the use of teaching skills in a social context and an understanding of the psychosocial aspects of rehabilitation: mobility is not a skill which can be taught in isolation.
For a little over a year the staff of the National Mobility Centre have been meeting regularly with the staff of the South Regional Association for the Blind and the North Regional Association for the Blind to discuss the future of specialist training and to plan such training. There seems to be agreement that the present rather fragmented approach to service provision could be better integrated, and that mobility, daily living skills, moon or braille may not have their greatest impact on a client if presented in isolation without due regard to the total situation of the client. Each centre had already begun to work on a more integrated approach and was considering teaching a broader range of rehabilitation skills. To this end the National Mobility Centre is co-operating with the Regional Associations in preparing a common course which will train workers to teach the full range of rehabilitation skills. The National Mobility Centre intends to consider where the new specialist courses might have a place within mainstream social work training.
In addition there will be appropriate input on other subjects which might loosely be termed "people skills" or social work related: for example, counselling and interpersonal skills, personal management, management as a function of agencies, and social studies.
In my opinion this is a positive step forward and a welcome departure from the separatist forms of specialist training that we have had to date. The prospect of change can be viewed as exciting or as threatening and I am aware that whilst taking on board the best that social work, education and health models have to offer, we must also preserve the best that exists in our own specialist training. Our present forms of
training are good; but are they good enough? It would be easy to feel complacent about the courses we offer, to take the safe way out and remain where we are. I hope we at the National Mobility Centre, like many of our clients, will have the courage to leave our safe seats and take the first steps forward.
The views expressed in this article are those of the author and do not necessarily represent the Royal National Institute for the Blind, the Birmingham Royal Institution for the Blind and St. Dunstans, the consortium administering the National Mobility Centre.
Bibliography
James, P. (1976), Mobility Training in a residential social
rehabilitation centre, New Beacon, October issue.
Thornton, W. (1968), Cure for blindness, Hodder and Stoughton
Ltd.
Welsh, R.L. (1986), Orientation and mobility for multi-handicap
blind persons, Paper presented at the 18th Annual Course,
National Mobility Centre, Birmingham.
Back to the Contentsby Rita Kirkwood
Deputy Head designate, Worcester/Chorleywood College
This article compares the methods of production of tactile diagrams by two distinct techniques. Since its recent introduction into this country, the raised copy image method has been used increasingly in the production of diagrams for the visually handicapped, alongside the longer established thermo-form method. The diagrams resulting from these two methods, and their suitabilities in use, are appraised. Some guidelines towards making raised copy diagrams using the Minolta beat copier are given, based partly on a working teacher's practical experience and partly on a case study.
Introduction
The study of A-level biology by blind students would present serious problems if the students did not have access to tactile diagrams. To date, most diagrams for biology at all levels have had to be produced by teachers themselves, a situation which has resulted in a build-up of expertise and diagrams in a limited number of schools.
Diagram-making
Tactile diagrams fall into two broad categories:
those which can be reproduced and those which cannot. Non-reproducible diagrams can be made either by using a spur-wheel or directly on to a thin sheet of plastic held in position by a film of water on a rubber mat. The making of reproducible diagrams necessitates the production of master copies and has traditionally been restricted to what can be achieved with the thermoform machine.
The making of thermoform masters is a time-consuming occupation. The keen master-maker will spend many hours selecting suitable materials with which to build up collages, ensuring that the juxtaposition of textures clarifies rather than confuses the issue. Recent work by Ron Hinton at Loughborough University of Technology (Hinton and Ayres, 1986) has resulted in the production of about 160 thermoform masters targeted for 0-level and GCSE courses. The project will be funded by the RNIB for a further two years to produce diagrams suitable for junior science courses, and to investigate production for A-level candidates (initially in human biology, but possibly extending to biology). Whilst this initiative will be welcomed by hard pressed teachers, it is also necessary to continue the evaluation of the potential of other techniques.
In 1984 Chorleywood College was presented with a
Minolta stereo copier which has considerably increased the
versatility of diagram production and has had a great impact on
the teaching and study of A-level biology.
In order to produce a master for the stereo copier a diagram is drawn on to a sheet of A4 or B4 paper, with the desired texture effects being added by either pen or pencil. Diagrams from books, often far too small for these purposes, can be enlarged and then relevant lines traced on to a separate sheet for the very rapid production of a master. Labelling in braille is the most laborious part of the exercise, as dots applied with a Perkins brailler have to be coloured in order to show as raised dots on the duplicated sheets. Photocopies are then taken on to the expanding capsule paper on which the final diagram will appear. Each sheet is then passed separately through the stereo heat copier, which takes about 20 seconds per sheet. All carbon-marked areas on the sheet are affected by the heat and are raised in the finished diagram. Like brailon sheets these diagrams can be brailled on to directly. Interesting textural effects can be obtained if a diagram is photocopied on to the reverse side of the Minolta paper. Thick lines or areas show through as white and raised, with an uneven surface. Diagrams can be drawn directly on the Minolta paper with a carbon-based pen or pencil, or can be added to, once made. (For advice about compatible photocopiers and other equipment contact the RNIB Diagrams Co-ordinator.)
A comparison between Minolta and thermoform methods
Table 1 shows a comparison of the diagram production by these two methods and their suitabilities in use. By referring to this table one can easily appreciate that the skillfully produced brailon diagram may be easier for a blind student to interpret where a high level of discriminability is required. Thus the Minolta diagram is of less value in biology teaching for the younger less experienced pupil, for those who have difficulty in diagram interpretation and also for complex diagrams at a higher level. It is however quite adequate for line drawings and for the presentation of graphical material at all levels. One problem that has arisen with this last mentioned
| Criteria | Comments | |
|---|---|---|
| Thermoform | Minolta | |
| 1. Time: a) producing masters |
Commonly 1 to 2 hours per master | 10 to 30 minutes per master |
| 1. Time: b) duplicating |
Rapid when producing a large number | Fast, but each has to pass through 2 machines |
| 2. Storage of master | Bulky, must be stored flat and best protected by one copy over the master's surface | On ordinary a4 paper, so can be stored in a file |
| 3. Skill required in production of masters | Much practice needed. Artistic skill an advantage | Easy to produce once parameters established |
| 4. Acceptability to students: subjective appraisal | Brailon not very popular as it is stiky when sweaty, but range of textures often appreciated | Variable acceptance, but generaly liked |
| 5. 3-D effect | Wide range of effects can be produced. Depth of master can very | Limited effects, as areas/lines tend to rise to same height |
| 6. Discriminability | Versatile, range of textures great | Less versatile in use so far. Less easy to discern subtle texture differences |
| 7. Versatility | All types of pictures, line diagrams, graphs. Need colouring, but can be tailored to individual requirments | Best for line diagrams and graphs. Good for pre-coloured raised graph paper |
| 8. Use as an active teaching aid | Cannot be added to easily, but can be brailled on to directly | Can be built up by adding lines etc. and repassing through one copier. Can be brailled on, but widthways A4 needs paring down to fit into Perkins |
| 9. Durability | Very long life. Eventually fay at edges | Not yet known, but tend to wear with much use. Black comes off on fingers |
| 10. Print labelling | Waterproof pens have to be used on brailon | Any pen, biro or pencil can be used |
| 11. For use with braille text | If thermoform text, can be bound together, but not same size as braille notes | Need separate binding |
| 12. Current cost | About 7p per sheet of brailon | About 20p per sheet of swell paper |
use is the inclusion of grid lines on graphs. The function of the graph needs to be assessed when deciding whether to include grid lines. If the aim is simply to appreciate the shape of the represented data, then grids are not usually necessary and their absence enables a more effective and rapid interpretation. If readings are to be taken from the axes, the inclusion of a grid is important. The problem is caused by the fact that tines tend to rise up to the same height when the diagram is passed through the heat copier, so reducing discrimininability. Attempts to read information directly using a set square to locate the co-ordinates have not proved very easy or accurate, although the recent acquisition of a drawing board may make this more successful. Recent work at Sussex University (Parkin and Aldrich, 1985) shows that drawing a grid with a very thin pen enables students to distinguish between lines. Another idea is to place a grid beneath the graph so that the lines can be felt when pressure is applied to the top sheet.
Another variable worth investigating when producing
Minolta diagrams is the heat setting on the machine. The height
of the raised line/ area increases as the setting is increased,
on a scale of 1 to 10. At first we tended to use the maximum
setting to give the greatest contrast, but now we vary it more.
At about setting 5 a thin line is more finely raised, i.e. has a
more pointed apex than at the maximum setting when
a surrounding margin of the line is raised as well. This affects the discriminability and highlights the importance of the constant evaluation and pooling of ideas when making diagrams.
A small investigation into Minolta discriminability
In order to mount a scientific trial to investigate discriminability of differing textures produced by the Minolta it would be necessary to have access to the following:
1. A representative group of the population of subjects from whom statistically valid data can be obtained.
2. A means of selecting test materials by having clearly defined criteria.
3. A means of controlling all variables as far as possible and of taking into account those which cannot be controlled. These constraints make such a study difficult and outside the scope of my current work. Hence the following findings should be seen in the context of the limitations imposed and as a working teacher's field study to illustrate the use of the Minolta, through the experience of one subject only.
The subject chosen was a totally blind VIth Form girl with very small hands and a high degree of sensitivity in her fingers. She is very able intellectually and probably represents the
upper range of ability in interpreting tactile diagrams. The material tested was in three parts:
1. Raised 2x2 cm squares of various textures,
2. Lines or combinations of lines 4 cm long,
3. Arrows and symbols in circles.
The subject was asked to feel each group in turn and to describe and make any observations that she could about individual samples. She was then asked to choose samples which felt alike, and finally those which were clearly distinct. The criteria used for choosing samples were based upon:
1. Their ease of production,
2. The likelihood of samples occurring in print diagrams or maps,
3. The perceived usefulness of the textures. Limitations of the samples were:
1. All samples tested were produced at the same heat-setting on the Minolta.
2. All samples were tested at one size only.
3. Samples were not placed close together.
4. No overlapping lines were used.
5. One person's experience may not be relevant to other people, although it may prove useful as a starting point for future work.
Table 2 shows some of the observations made by the
subject.
Further amplification of her observations may present points worth bearing in mind when making diagrams:
1. Not all visually distinct Tines or patterns are
factually discernable (see 2(b) and 2(c)).
2. As expected, larger patterns are easier to detect. When small, as in 2(a), the surrounding margins of the lines, which are also raised, run into each other.
3. The symbols in the circles were distinguishable, but the subject could not describe the shapes of the symbols accurately.
4. The margins were not distinct from the patterns. When adjacent, areas of pattern need either to be separated by a detectable gap or to be composed of clearly distinct textures, as in l(d) where both halves were distinct to the subject.
The observations made by the student in this case, and ongoing teaching experience, both lead me to conclude that diagram effectiveness is aided by:
1. using large areas of texture of distinct patterns clearly delineated from one another,
2. keeping the number of different textures on any one diagram to a minimum,
3. always checking with the students as to the effectiveness of the textures.
Conclusions
Most visually handicapped children need a great deal of practice at interpreting diagrams, especially if they have no useful vision. Much thought, therefore, should go into the production of diagrams if they are to be effective. Rarely can a print diagram from a textbook be translated line for line into a useful tactile diagram. As noted by E. Beria and L. Butterfield (1977), training improves shape recognition and the speed with which subjects can locate shapes on a map. They stress the importance of training blind students to become systematic and analytical in their approach to tactile material in order to help their perceptual development. Even at VIth Form level, diagrams, other than simple line diagrams, should be studied for the first time in class. It is an important aspect of progress that students should be given sufficient time and help to become competent in the use and interpretation of diagrams. The ease and confidence with which students can tackle diagrams varies considerably and it is a skill which requires a long apprenticeship. After there has been class discussion, experience shows that diagrams can usually be used successfully for private study. My own attempts to provide diagrams which can be interpreted independently by VIth Form students by referring to either braille or tape have proved partly successful as long as there is an opportunity for subsequent discussion. This is very time-consuming and so has to take up only a limited amount of time when syllabus demands are great.
Some guidelines for diagram-making could be summarised as follows:
1. Whether making thermoform or Minolta diagrams, do not rely on visual criteria as they are often misleading when determining tactual discriminability.
2. Diagrams are more effective as information transmitters if they are uncluttered by un-
necessary detail, therefore the following points should be borne in mind:
(a) Do not clutter diagrams with line-crossing labelling lines. It is advisable to keep guidelines on diagrams to an absolute minimum. Children can braille on to diagrams and put in their own guidelines if necessary.
(b) The diagrams should be large enough for easy discrimination of different features. This is often a dilemma for the teacher, as detail has to be sacrificed for clarity.
(c) Place materials with contrasting textures side by side and emphasise the edges with string or wire if that helps discriminability on a thermo-form diagram (Pickles, 1968). 3. Use thermoform masters built up in layers to give a greater 3-D effect. This is very helpful when students are attempting to understand a 3-dimensional object in diagrammatic form. In this way a diagram approaches a model. 4. Diagrams should always be made with the users in mind; their age, familarity with diagram work and ability.
It can be appreciated that, as an instrument which increases the diversity and makes the production of diagrams more rapid, the raised-
copy image method will prove to be a valuable instrument in education for the visually handicapped. Its advantages however should not be allowed to obscure the benefits of the thermoform system, which has already proved its worth as an effective and versatile means of producing high quality diagrams. Clearly there is a need for both techniques in the production of tactile diagrams and also for further research.
References
Beria, E. and Butterfield, L. (1977), Tactual distinctive features
analysis: training blind students in shape recognition and in
locating shape on a map,./. Sp. Ed. 11 335-346.
Hinton, R. and Ayres, D. (1986), A collection of tactile diagrams
for first examinations in biology: construction and evaluation,
BJVI IV: 1.
Parkin, A. and Aldrich, F. (1985), Tape recorded textbooks for
the visually impaired: how do we present graphs, diagrams and
other non-text displays? Discussion Paper, Laboratory of
Experimental Psychology, University of Sussex.
Pickles, W.J. (1968), Raised diagrams in The teaching of science
and mathematics to the blind, A report to the Viscount Nuffield
Auxiliary Fund, RNIB.
Back to the Contentsby Paul Blenkhorn
Research Fellow Research Centre for the Education of the Visually Handicapped, Birmingham
This article gives an overview of a project on micro-computer systems and computer assisted learning for blind and partially sighted children and adults. The major area of interest in the project has been in developing and investigating ways in which computers can be useful to the visually impaired and make existing programs accessible to them. As a result there is now available a wide range of computer based materials for users ranging from the pro-school multi-handicapped child to adults in employment. Work on this project has been going on at Birmingham University's Research Centre for the Education of the Visually Handicapped for the past three years.
The general approach
The general approach of the project has been to try to make the materials produced as flexible as possible. Most of the programs have a 'menu' which lets users set parameters such as: the size, colour and speed of objects; the devices which are used for input to the computer; and the use of speech synthesis devices for output. It means that, within certain limits and where appropriate, programs can be configured to suit a user's sight and developmental age. The option to change the devices which are used for input to the computer is of importance mostly with the young or less able where the computer keyboard is not really suitable. With many, but not all, older and more able users, the computer keyboard seems to cause fewer problems than it does with sighted peers — typing being taught as a matter of course to many visually impaired youngsters.
It should be noted that, unless stated otherwise, all programs have been produced for the BBC micro range of computers. All of the programs require at least a single disc drive. Any other peripheral equipment is added to the system as required.
Materials for pre-school, primary age, and less able pupils
In terms of actual numbers of discs produced, this
has been the most productive area, and the majority of these
discs could be loosely described as associated with visual
perception training. It has been found that for many children the
computer's screen is a very attractive means of presenting
information, with multi-coloured moving images catching the
attention of some children who had seemed to have very little
sight. The light is emitted from the screen and this can
give a good contrast to images on the screen, especially
if the room is darkened. The major problems with this are that
with the BBC micro one is limited entirely to
the area of the computer screen (which is relatively small); the
'objects' which can be
presented on the screen are of necessity two-dimensional; the colours available on the screen are limited; and it is not possible to draw on the screen in any great detail.
Many of the programs which have been produced can be used with a variety of peripheral devices for input, such as joysticks, switches, the Concept Keyboard, the MicroMike (a CB mike with which the computer can detect the volume of sounds being made) and touch sensitive screens. All of these devices have their place but the one which is proving most useful is the touch screen. All the other devices have to be used away from the screen. This can cause physical, visual and perceptual problems. In many cases when a child is given a device to hold and interact with, he tends both to hold and to look at the device itself. This causes problems when the effect of interacting with the device occurs on the screen — the child looks at the device and not at the screen! This difficulty is largely overcome with the touch screen. Here the interaction all takes place in a 14 inch square i.e. on the monitor. A problem with the touch screen, however, is that a 14 inch square is not a very large area to interact with, and it does restrict the size of images which can be presented. Even so, it is probably the most useful peripheral for the very young with some sight.
Some materials have also been produced for the totally blind. The problem here is that the work really has to be done either with synthetic speech or with sounds/music. Many adults find synthetic speech difficult to understand and are thus put off by it, but children do not seem to find this too much of a problem. Some training is needed to get used to the 'daiek' voice. (All of the experiences with synthetic speech with children to date have been with those over the age of five; it is not clear how pre-school children would cope with it.) Another problem is that even when the speech can be understood it is not really as 'exciting' as the graphics which appear on the screen. The speech-based materials, although highly motivating, do not appear to have quite
the sparkle of some of those which are screen-based. Some work has begun on materials which use music and it is hoped to develop this further.
Braille and typing skills
Several discs of programs have been produced which can be used in the area of learning braille and typing skills. On the braille side these include some simple tests for blind children learning the initial braille cells, a more sophisticated system for use with sentences, and a program for sighted adults who are learning braille. For typing there are talking and large print typewriter programs, and a copy-typing program which works in large print or with synthetic speech.
SMILE maths software
The project at the Research Centre concerned with SMILE Maths was to modify 30 programs to make them more accessible to both blind and partially sighted users. These programs were originally produced to complement the ILEA SMILE maths scheme. They cover a wide range of topics that appear in secondary school mathematics curricula, although some of the programs are also applicable to the upper end of primary school work. The programs were modified so that the display of the information could be adapted to suit the visually impaired with some sight, and for the totally blind an option for synthetic speech was added. A reporting facility was built in, enabling users to take away a printed summary of their sessions for review by the teacher, or for their own files. In addition, the original programs (which had been produced by a team of workers) were made more homogeneous in their interaction so that, for instance, a beep would always occur if the user pressed the wrong key. However, as far as possible, care was taken not to take away the specific originality of the programs.
(A major difficulty encountered in this project was that many of the programs were working almost to the limits of the computer's memory and so a great deal of work had to go into compressing and rewriting the programs to add the features which were required.)
Braille translation
Two systems of interest have been developed in the area of braille translation:
1. Braille to text system
This is a program which will transcribe from Grade
II Standard English Braille into print. (It will also transcribe
Grade I French and German braille into print.) Again, some effort
has gone into making the system flexible in its operation. It
will, for example, work with a range of devices, including
modified Perkins braillers, Versabraille and text-to-speech
synthesisers. It can be configured to be employed by a sighted
user or by a blind user. This program is being quite successfully
used in a variety of environments, including schools (both in
classrooms and
for exams) and by adults in employment. It should be noted that there are several problems associated with such systems.
(a) The program will not transcribe all Standard English Braille into print as there are several ambiguities which the program cannot resolve.
(b) The program will not transcribe mathematics or musical braille.
(c) The program will not differentiate between Grade I and Grade II braille i.e. the program will transcribe both 'good' and 'gd' to the same print equivalent and will not register that one of these is not correct Grade II braille. This is important for the teachers of braille to realise; just because the print copy of a child's work is correct, it does not mean that the original braille was correct.
2. Text to braille systems
This is a system which will transcribe from text into Grade II Standard English Braille. Some people see this type of program as a general panacea for all their braille production problems, but it should be emphasised that this is far from being the case. The first major stumbling block is that a braille embosser is required, and an appropriate model for a school will cost between £3,000 and £11,000. The second is that instead of having to sit down and braille a piece of work, one now has to sit down and type it into the computer and then go through a (not trivial) process of getting the computer to convert it into braille and then to emboss it. However, if typing support is available, then this particular drawback can be overcome.
One facility provided with this system enables a user to proof-read and edit the braille which the program has produced on the screen. (It actually modifies the word processor VIEW which is a commercial product.) This enables the braille to be checked, if necessary, as it should be noted that no braille translation program is perfect. This facility is also being used to enter braille direct into the computer;
it can then be edited and printed as above.
Screen reader
There are several approaches to making computer-based materials accessible to the visually impaired.
1. A program can be written from scratch to meet a particular need. This approach is in many ways the most effective in that the problem can be tackled directly and the most suitable solution developed. This is the way in which the programs for the less able have been developed. However, in the real world there are not always the resources available to do this in all cases, and in some areas (perhaps more for social than for educational reasons) one would want the visually impaired users to be accessing the same programs as their sighted peers.
2. One way in which existing programs can be made accessible to the visually impaired is by following the approach which was adopted for the SMILE programs i.e. take existing materials and modify them. The problem here is that this can still take a great deal of time, the programs
may not be of a totally appropriate style, and the outcome is nearly always a compromise, leaving uncertainty whether the first approach would have been more appropriate.
3. The third approach is to concentrate on the computer rather than the programs and to modify the computer so that it becomes a talking, a braille, or a large print machine; thus anything which runs on the computer should (in principle) be accessible. This is the approach which has been adopted with the Screen Reader systems and which is discussed below. (Those who are familiar with the Frank Audiodata or the TSI Vert or the Maryland ITS will find that Screen Reader uses the same general style.)
What the Screen Reader software does is to modify the computer in such a way that existing programs can be accessed by visually impaired users. So far, this has been done on the BBC range of micro computers, and on the NEC portable computer using both synthetic speech and a good size (15mm high) clear display. The approach taken with the Screen Reader software is different, depending on whether speech or clear print is used. With the clear print the user always sees a 'window' on the screen. This window will normally show the 16 characters around the area in which the user is currently entering text (at the cursor position). However, if necessary, the user can move this window away from the cursor and can view any part of the screen. (Although no work has yet been done in earnest to get the Screen Reader working with braille, this same approach would be followed if one was using a refreshable braille display.) In the case of synthetic speech the system will speak characters or words as they are being typed. In addition, the user can choose to review any part of the screen by character, word or line.
A major advantage with this method is that visually impaired users can access existing (commercial) software. They are thus not restricted just to those programs which have been produced specifically for them. In addition, once the Screen-reading style has been learnt it is only a matter of learning the new program, not of learning a new program and the way the speech/clear print works with it.
However, there are some problems with the Screen
Reader system. As it is designed to work with as many commercial
programs as possible, it is quite sophisticated, and as such is
not easy to learn. At present, it is not really suitable for
primary school children. The system will not be able to interpret
graphical information, and in fact the graphics on the screen are
ignored. Also, being a general purpose program, the system is
never totally ideal for any individual program. Some effort has
gone into trying to alleviate this. Customised versions of the
Screen Reader program have been produced for the Wordwise(-Plus)
word processor and the Inter-Sheet spreadsheet program. Here the
Screen Reader system has been modified slightly to give some
extra facilities which make the system more closely linked with
the commercial product. Although
this still does not give an optimal solution, it is proving a good compromise.
Other software
There are several other areas in which the project has been active. Some work has been done with large print on the computer screen, and a program has been developed which will produce large print on an Epson printer. Teletext (Ceefax and Oracle) have been made accessible with speech, large print and Grade II braille. For further details of the software, readers are referred to the project newsletter which is available from the Research Centre.
Additional areas covered by the project
(i) Producing information
Several information sheets and articles have been produced dealing with the use of the computer, equipment available and guidelines for the management of the computer. In addition a newsletter is produced three times a year. This has details of what is currently being developed by the research project and of all software produced to date. It also contains articles by other developers and users of computer-based technology.
(ii) Working with schools
The work with schools is a two-way process. The Research Centre has arranged a series of courses introducing teachers to technology and demonstrating the materials which have been developed;
but the schools have also played a fundamental part in the work by coming forward with ideas for programs and helping with the evaluation of those programs. Working groups of teachers and other interested individuals have been set up. These groups meet regularly and exchange information ideas and software. There are currently two active groups for 'Communication aids' and for 'Primary skills, the less able, and the multi-handicapped'. (Any reader wishing to be involved in these groups should contact the Research Centre.)
Concluding remarks
Although a good deal of software has been produced which is proving useful in both schools and employment, the first three years could be seen as an exploratory period. Having learnt many lessons from the systems developed to date, the researchers hope that the next few years will bring more adaptable and easier-to-use materials. It is also hoped to consolidate the work which has already been carried out in such areas as 'Visual Perception Training/Testing'. Many of the programs which are in the 'ideas' stage should be improvements over what has been done so far, but it will not be possible to implement some of them on the BBC micro, owing to limitations of size and speed. Some thought is currently going into what should be the next range of micro-computers on which materials will be developed.