Low Vision and Learning

by Federico Bartolomei and Mario Barbuto

Educational counselling service for children living with vision loss.

A person with low vision is, by definition, living with an irreversible visual impairment, which cannot be improved with conventional optical systems. It is so to such a degree that will not allow performance of common daily life activities.
During the years of development and schooling, the visual functionality is closely correlated to the global evolution of the child, in his perceptual, psychomotor and neuropsychology dimensions, three aspects closely linked together. On the basis of this preamble, it is obvious that a severe congenital or early defect in any functional environment cannot be considered alone. It inevitably interferes with the development of other functionalities or subfunctionalities, involving the functioning and psychological elements, consequently limiting participation in social life.
Therefore, the rehabilitative treatment has to anticipate a series of interventions at the health, social, psychological and environmental levels. In other words, this means that the integrated process needs to involve closely related strategies that will maximize all of the individual's residual resources, adapting the environmental, structural and social characteristics, and also managing the eventual psychological repercussions.
The definition and quantification of a visually impaired child's residual abilities requires more often than not a multiexpert and multidisciplinary approach to outline the rehabilitative program. To better understand a visual limitation, it means that generally a child will see little and not well with both eyes, from a distance or from up close, even with the use of glasses, with a visual acuity equal to a maximum of 30%, and a field vision equal to 60 % compared to children the same age. The child will therefore have a lot of difficulty looking at images and reading small print, or be limited regarding orientation and mobility.
The limitations mentionned above are closely linked to the nature of the visual impairment. There can be central vision deterioration with consequencial difficulties with reading and interpreting details in images, or deterioration of the peripheral vision where space is perceived in a more narrow fashion, like a tube, which makes mobility and object interpretation difficult. From the typhlo-pedagogical and rehabilitative point of view, to confront these problems means that a close collaboration needs to be put in place between the family, the school, and the professionals who deal with the treatment and rehabilitation aspects of the individual.
We have already discussed the numerous and significant consequences on the quality of the overall development of the child that an impairment can cause, but maybe some considerations and a few examples, from pedagogical experiences, can bring more light into it.
Learning, observing, comparing, associating, moving, in short, the meaning and the pleasure of learning and expressing oneself, and the building of self esteem are at risk when one experiences a sensorial, perceptive and visual impairment.
The degree of these is not easy to determine. At first, even the child can be of little help since the visual condition he is experiencing is perceived as "normal" because it is the only one that he knows. Most likely, the child has already adopted some behaviour to compensate the visual impairment. School will offer new and inevitable means of comparison and awareness of the various possible performances. At school, a child with sight problems sitting far away from the blackboard may not see it, which will result in learning difficulties. He may not be able to take advantage of the educational value of educational videos, or images and alphabet letters on cardboard placed on the classroom walls. The child may not be able to interpret rapidly mimics or gestures which support oral communication of teachers and classmates. Consequences of difficulties with near-sightedness are also indubitable: reading, writing, and drawing difficulties. This creates great tiredness and lost opportunities for reinforcement, control and fulfilment.
In all these cases, "school performance" is affected by the gravity of the impairment. To reach adequate results according to school expectations, the student will have to double the efforts much more than sighted classmates. An enormous quantity and quality of information is lost. This lack of information can reduce experience and strengths and have a significant impact on the learning experience. To compensate, it may be possible to set up different educational programs.
In the presence of a severe visual impairment, even a simple homework where the student needs to recognize and link two dots on a piece of paper becomes a task requiring perseverance and skill.
When vision is limited, putting together a photographic context, a geographical or artistic image requires a demanding and intense activity of organizing the perceived elements and, only with a lot of work, is it possible to outline a synthetic mental representation of the whole image.
Sometimes there can also be a change in chromatic perception: a colour can be mixed with another, limiting the ability to identify an object from the background. On the physical geography map, the little red balls indicating cities disappear in the green prairies, the blue Po with its affluents is not longer found in-between valleys and at the foot of the Alps, and at the end of its journey the mouth on the Adriatic coast is lost in some grey similar to the blue of the sea. The first example of a sentence analysis on the blackboard, with the subject written in green, the verb in red and the complement in blue, becomes a grey puzzle which is resolved only with much attention to oral explanations.
Some pathologies can create difficulties in adapting to light with symptoms similar to photophobia and dazzlement, the child is not able to stand lighting which would be pleasant to others. In class, it is possible to use window curtains or to have the child sit far away from the windows. Difficulties in adapting to dark places can lead to a symptom called "hemeralopia" (day-blindness) a reduced vision when light fades away: in class, the other students will appear to be in the darkness when there is less light.
The child reaches literacy through an experience which begins the first months of his life until formal training. Even the writing experience does not appear by magic at the age of six. It is the result of the cognitive, psychological and psychomotor development journey that the child begins way before he is shown the first letters of the alphabet. It is fundamental to understand that learning does not relate to what is taught only, but it is based on the ideas and knowledge that the child has built himself while spontaneously playing, while interacting with others and the environment. Consequently, the learning path cannot be standardized. It has to stem from that specific situation, in school or not, and from information that is shared from time to time.
Aids will be chosen not on the basis of chronological age or the school year a child is in. It is important to emphasize that the methodological choice is guided by the student's own potential, ability, and requirements in that moment and for a given task.
It is important to succeed in working with the child to find the right devices which will be useful. It means adapting or modifying a procedure intended for a large audience and make it efficient for one person.
In the various learning situations, it is nevertheless important to preserve the emotional value, the pleasant feeling of entertainment, the pleasure to do things, the free investment of mental energy for a desired goal.
In regards to aids for persons with low vision, except in severe cases where it will be necessary to proceed by degree with the teaching of Braille, the tools that are used are generally to enlarge characters and images or to obtain images electronically. Basic aids are: textbooks with large print and notebooks with wide spacing, CCTVs and large screen software with voice synthesis to use with the personal computer. The transcription of texts or duplicated lecture notes in Braille or in large print are done by organizations which provide schools with the material they request.
Some tools are usable by the whole class. The map of the world, for example, can have raised contours and lines. It can be in colour (for students with low vision and the rest of the class). It is easily read with the fingers as well as with the eyes. It has two legends at the bottom, about continents and oceans, written in Braille as well as in print, and it becomes an instrument of integration for regular teachers and special educators as well as students.
In order to be used by visually impaired students, some tools have high level chromatic contrasts between the text and the background or images.
There are other raised-line material used for tables or graphics in various disciplines and which are reproduced in Thermoform (a technique used to create raised forms or lines on a special paper).
The hands-on experience of situations, objects and tools (not only what others say about them) is essential for the visually impaired to develop mental images of the reality, concrete knowledge of what they learn. Therefore, it is fundamental to begin with real and concrete elements, in order to gradually arrive at a symbolic representation, using all possible material and tools to represent an object, to describe a discipline and to keep the student participating as much as possible and as in much harmony as possible with the rest of the class.
Even for drawing there are various tools, some for bidimensional representation of the first objects known, others are used for the reproduction of geometric shapes (eraser, ruler, T-square, compass, etc.).
In conclusion, we believe it is useful to mention that whatever activity is planned for the child, it has to start from subjectivity, otherwise there is the risk of facing qualitative and quantitative obstacles: qualitative when functional objectives are imposed by a standard protocol that is not personalized; quantitative when work deadlines are postponed indefinitely with the illusion that an objective can be reached without first evaluating the child's potential. Educational aids, whether they are designed for blind or low vision people, are tools that have a value corresponding to the knowledge professionals have of them and how well they use them in the context of a global rehabilitative project.

References

Cannao M.1989, "Ipovisione. I problemi dell'età evolutiva", in "Saggi", year XIV, monographic issue. Cannao M., 1999. "La mente con gli occhiali", Milano. Angeli Colombo E., "Disturbi visivi complessi e didattica specializzata", 1984, Saggi. Delpino E., Gallo G., Gettani A., Pieri P. "Giocando s'impara. L'apprendimento della scrittura nell'ipovisione". 1999, Istituto David Chiassone, Genova. Grassi N. "Elementi di tiflodidattica. Giornale di ipovisione". Professional Optometry. Vigneux F.