entative Communication Septen$er, 1994 Vol. 7, No. 5 C Ittgon Ttttslssan. . , IJPFRONT Thir irru" focuses on seeing. People who have severe speech/language problems, developrnental disabilitiesand neurologicproblemsoften have visual impairments M). Vision has a profound impact on the selection anduseof augmentative and alternative communication (AAC) symbols, devices, techniques and strategies. Unfortunately,a cunory review of the literature reveals little information about VI andAAC. My goals are to raise awareness about VI and AAC practices pertinent to persons wift low News andconsumers areencouraged to seek professionals who under- stand VI and can helpAAC tearns makeaccommodations for visual problems. This issuedoes not specifically address individuals with both hearing and vision problems.Dual sensory impair- ments were highlighledin a previous issue of AICN.' What's to bedone? Try o ima- gine what it might be like to see differently. Sighted peopletruly can neverknow what it is like o beblind, have avisual fielddeficit or cataracts. However, those who are developing communication solutions for individuals with VI must be sensitive to dre impact visionhas on (coa. onpage2) oo For Consumers .RflI TfY The ABC'Sof IE visionin AAC lr More people experience visual impairment (Vl) than any other type of functionalloss. If you haven't yet, just wait! Presbyopia lurks around ftat 40th corner! VI is a term usedto describe visual acuity between 20/70 and 201200. Legally blind means visual acuityof 20/200or less in the better eye with corrective lenses, or a visua! field lossof 20 degrees or more.' Leeal blindnessis an old-fashioned coicept, rooted in the premise that vision -rnuch below normal is useless.' Nearly 40 million people world-wide are classified as legally blind although most(80%) have some resrfual vision that may be usefirl.' Approximately two-thLds of all pmple with VI are over 65 years of age. The prevalence of VI and blindness among minorities ishigh-the rate for African-Americans is double that of whites of copparable socio-economic status.' Manv individuals with multipli impairments have VI. Between 75 and90% of school-aged children with severe/profound cognitive disabilities and approximately 40% of those with cerebral oalsv (CP) have visual problerns.6 Functional vision*vision that is reasonably useful-requiresa fairly intactvisualsystem and the motivation, experience, and understanding a person brings to the 'seeins" task. ' (cont. onpage 2)
People who have severespeech/ language problems,developrnental disabilities andneurologic problems often havevisual impairments M). Visionhas a profound impact on theselection and use of augmentativeand alternative communication(AAC) symbols, devices,techniques and strategies.Unfortunately, a cunory reviewof the literature reveals littleinformation about VI and AAC.
My goals are to raise awarenessabout VI and AAC practicespertinent to persons wift low
News
and consumers are encouraged toseek professionals who under-stand VI and can help AAC tearnsmake accommodations for visualproblems. This issue does notspecifically address individualswith both hearing and visionproblems. Dual sensory impair-ments were highlighled in aprevious issue of AICN.'
What's to be done? Try o ima-gine what it might be like to seedifferently. Sighted people trulycan never know what it is like obe blind, have a visual field deficitor cataracts. However, those whoare developing communicationsolutions for individuals with VImust be sensitive to dre impactvision has on (coa. on page 2)
oo For Consumers.RflITfY The ABC'S ofIE vision in AAC
l rMore people experience
visual impairment (Vl) than anyother type of functional loss. Ifyou haven't yet, just wait!Presbyopia lurks around ftat 40thcorner!
VI is a term used to describevisual acuity between 20/70 and201200. Legally blind meansvisual acuity of 20/200 or less inthe better eye with correctivelenses, or a visua! field loss of 20degrees or more.'Leea l b l i ndness i s an o ld - f ash ionedcoicept, rooted in the premise thatvision
-rnuch below normal is useless.'
Nearly 40 million peopleworld-wide are classified aslegally blind although most (80%)have some resrfual vision thatmay be usefirl.' Approximatelytwo-thLds of all pmple with VIare over 65 years of age. Theprevalence of VI and blindnessamong minorities is high-the ratefor African-Americans is doublethat of whites of copparablesocio-economic status.' Manvindividuals with mult ip l iimpairments have VI. Between 75and 90% of school-aged childrenwith severe/profound cognitivedisabilities and approximately40% of those with cerebral oalsv(CP) have visual problerns.6Functional vision*vision that isreasonably useful-requires afairly intact visual system and themotivation, experience, andunderstanding a person brings tothe 'seeins" task. '
(cont. on page 2)
News
A@eo4o4ourueadon 1r
For Consumers @oit.lon paee t)
The visual systemThe visual system is complex.
The process of seeing involves asequence of events-fte receptionof light and sensory stimulitlrough fte eye, the frammissionof electical impulses along theopic nerve and fte interprerationof ftese impulses as an image inthe visual cortex of the brain. Theanaiomic structures involved arleinterrelated and very complex,"Optometrists, oph&almologists,VI specialists and manufacturersas well as some psychologiss,educators, administrators andfamilies, focus on solving the com-plex problems of individuals whoare blind or visually impaired.
What can go wrong?Low vision and blindness limit
ttre quality and quantity of aperson's experiences. Difficulties
may originate in the cornea, lens,retina, optic nerve, brain stemand/or other parts of the visualpathway up to and including thevisual cortex. Conlmon visual im-pairments include:'
r Nearsightedness. Can focus upclose. but vision is blurred at adistance.
r Farsightedness. Can focus at a dis-tance, but vision is blurred up close.
r Astigmatism. Visual inage is dis-torted. Usually accompanied bynearsightedness or farsightedness,
r Catrracts. Lens becomes opaque,obslructing part or all of view.
r Glaucoma. Peripheral visiondiminishes. Can cause total loss ofvision.
r Detached retina. Retina comes loosecausing blindness or blind spots.
r Macular degeneration, Failure ofthe small regiou in center of retinacausing blind spots. Can interferewith fine discrimination needed forreading and using graphic symbols.
r Strabismus. Convergence andmuscle irnbalance resulting in poorfocus or double vision makes focus-ing, fixing and hacking Dore dif-ficult. Binocularity occurs in manycbildren with CP.
r Amblyopia. Reduced visim fromlack ofuse or lack ofclarity ofvisionduring eady childhood. A conse-quence of strabismus.
r Hemianopia. I-ack of peripheralvision on one side of the visual fieldof both eyes. Requires active scan-ning of visual information.
r Visual field defects. Blind ryotswhich result in a lack ofawareness(neglect) of objects. Requires activescanning of visual information.
. Nystagmus. Oscillations or hemrsof the eyes occurring independentlyof normal eye movements.
Finding solutionsMore than one type of visual
problem can occur so it can takeyears to figure out the functionalvision of multi-handicapped ind"ivi-duals who are unable to speak.' Inaddition, a range of accomrnda-tions can be made: and mofe andmore visual problerns are now'fixable" using less invasive tech-niques. Be sure to check with aknowledgeable developmental orbehavioral optometrist. Table Idepicts components of vision thathave an irnpact on the selectionand use of AAC techniques.
VNml acai$. Iryaired acuity, witha variety of e{iologies, i6 the mstcommon visual problem. Visualacuity alows us to discriminate detailsclose up and far away. Acuity inpair-ment classifications vary from partial-ly sighted to totaly blind and includevisual field d€f€cts.AAC system dccommoddiotv. Con-sider the size, position and type ofsymbols being used, how they arepresented and how the individual willselect them. Color and mntrast (i.e.,figure/gromd) can greatly enhanceacuity. I ighting also is importanLVisuaUtc I& - Mappng visual fi elds todetermine the location of blind spotsis helpful. Central fields discriniratecolor and shape in daylight condr-tions. Perioheral fields are sensitive to
motion, contrasts and low light condi-[ons. People who lack cenhal visiondepend on peripberal visiou and may0,lrn away fiom an object/person inorder to see it with peripheral vision(i.e., eccentric viewing). Be carcfi.r".This nay be confrrsed as a positioningrather than a visual problem.MC accomnodations. Just becauseyou have a good map of a person'svisual fields doesr't mean you knowabout frmctional vision. Check to seohow "blind spots" affect function. Ad-justrnenb in positioning of symbolsand displays and in mounting devic€smay be necessary.O c ultmnto riu n ain nin g. Eye musclesallow people to scan, locate, fixate andtrack moving objects. People mayn€ed to shift their bodies to 'nakeaccommodatioos. If motor problemsor positioning constraints interfere,seeing can be difFcult.MC accommodatiotts. Pay attentionto the design of displays, Adjust thepositioning of a person and/or equipment. Sometims the angle ofa displayis critical. How tbe person tilts his/herhead also can rnake a difference.
Light and color rerrsiti.uitl.Color and illumination factors canvary with the type ofVL For example,as we age and presbyopia occurs.more light is required to see. Sen-sitivity to certain colors may bedepressed depending on tbe visual im-pairment, but color blindness is rare.MC acconmodntions. Appropriateuse of color and lighting enhancesacuity and nrakes perception easier.Illumination on a display or devicescreen must be adequate and withoutglare. Sunny days can be a problem.Back lighting is important. Colorprovides contrast, Yellow back.grounds are often better tban white.Confual visinn. Cortical visual im-painnent (CVt) occurs with damage tovisual pathways leading to and includ-ing lhe visual cortex. It is generallycaused bya lack ofoxygen to $e brain(anoxia).' Prcmaturity is a majoretiol-ogy of CVI as nrore fragile babies aresurviving. CVI also occurs followinganoxic evenls associated with headtrauma, hydrocephalus, meningitisand encephal.itis. Shrdies suggest agradual visual recovery exlended over
several montln !o years in people whoacquire CVI. Those who have con-genital CVI bave more difficulty be-cause leaming is so dependent onvision and other problems associatedwith brain darnage are often preseDt.Clinical sympioms of CVI includevisual inattentiveness and a lack ofvisual acuity. Because eye movementsare not affected, individuals n4y notappear !o have impaired vision. '"
AAC accommodqtions. Iadividualswho are unable to aitach meaning tovisual information remain severellcompromised in learning, languagedevelopmetrt and communication.CVI will interfere with the use ofAACsystem cornsronents. l0 Children wi$rCVI often benefit from auditory scan-ning and motor experiences that allowthem to interact with and leam themeaning ofobjects, events and people,Motor memory (.e., the mental map\ e USe !o carD/ OUt our roie rrove-ments) may be critical to an individualwith cortical blindness io establishrneanins. " A sood source ofinforma-tiotr is tie deaiblind li!"r"tu
".12'13'14 ^
I
ruEffect on AAC desiqnComoonent Delinition Normal Impairment
Visual *uity
Clarity ofvision rpclose rldfrom adishnce.
20120 (distrnce fiomstimulus required to
person with norrnrl vis-ion). Normal fields.
May be caused by an unclesr leis sy$em,refrsctive errors, ocular-motor problens,darnrge to the retinr or optic nerves orirnpsired sbility !o inl,e.pr€t vi$.slidformrtion in the brain.
Affects type and size of symbols as well sscolor and cofltrast between sfnbols srdbactground in a display. Need to consideroptimal distance of lhe display ftom AAC userand usea's illumination reouirqnents.
Visud rus
Areas inwhich obje.tgsre visiblewilhout ashift io gszc.
150 degree arcs ftomright to le&. 120deg.ee8 up erd dovrn.High acuity in centrelfield. Peripheral felddetects movemerL
Blind spots vary in shape and size.Certal - difficulty seeing dt midlirD.PeipheralfuA - diffiwlty moving becausecan't delect movement or locate objecls onthe side or below. Per€on rnay becorllt ndy $ifiing posirions to accomodate.
Need to know the locatioa of affect€d ar€!s.their size and shape and how defects sffectfunciionsl vision. May require adjushrrrt ofpoint of fixatiotr and hesd position. Oftenaffecls proper plrcement and arrargemerl ofsymbols, devices and materials.
OcdoBotorfr||rcfioniq
Movem€nt of
Musclescootrdunified focu8.
Eye muscls eshblislrrnd Daintrin vi$dfocu3. Scrn, fixate,locale and trackobiects,
.Strlisrus - focus is con{rromis€d trerausedi.cction of eyes is not coordimred../\tsraSrns - involuntrry nrovments ofeyeresulting in reduced visual acuity. hobablynot a muscle Droblem.
May need lo adjust herd and body posilionr iocompensate. Affects location snd orienlstion ofdevice/display, configurarion of syrnbol arrayand spacing of items on the dirylay.
Lightseositirig
Arnount ofrmbient lighrrequired to
Daylight or rnediumanifi cal illumination isad€quate.
Vr.i* acco.diog to the etiology ofthevisual problem. Those vrilh relimlproblems nuy require low light corditions;thosc with rcr.sightedness or prrsbyopiamay requirc inc.eas€d illumimtion.
Need sdequate Iighring for dispbys. will rarywith lype of disorder. Positioning of naierialsand use of non-reflective surfaces can decrei!€glare, Sunshine is a problem with conpulerdisplays and AAC devices.
Colorseositivity
Perception of A tull spectrum ofcolor bssed onstructures within lheeye being stimulated atspecific wave lengths.
Soote disorders depress the receptioo ofcerlrin colo.s (e.9., colrracts). Tot l colorblindness is .are (E% rnale{ lrd .415females). Red rnd green ere nro* oftenconirsed.
Use colors on displays that are helpftl to user.Color vision will vary with type of inpairrEntso be caieful when using color codes. Colorscan help provide good contra$s.
Cortical visln
Ability tomrerPreavasu3linformation
lolact visual pathwaysup to and including
perceive, interpret ard
Visull inattentiveness. Irct of visral acuitycaused by centaal nervous syd€m daimge.Inconsistency, fluchrations in furrliomlvision rnd perception. A$ociated withsevere cognitive/molor pft 6lernr.
AtLching meaning to visual images, irpludingsymbols is problemaric. I-e{m;ng iscompromised. Tactile and auditory inpur isc.ilical. Requires manipulation and experienrial-based instruction.
Erentaft\reC.ommunication
.1\
News)
Glinical NewsSeeing is
what seeing does
From birrh, eye contact bindsmother to child. Paralinguistic fea-tures (i.e., gesture, facial expres-sions, proxemics and eye contact)underlie the effectiveness ofhuman interaction. According toLea Hyvarubeb, M.D., "severelyvisually impaired children losethousands of hours of incidentallearning and visual communica-tion and have to build numerousconcepb on patched informationwitlr obvious -boles in fteirknowledse. -r) Individuals whoalso are inable to speak, par-ticularly those who have motor im-pairments, lose many thousandsmore. Most poople widr VI need asighted interpreter who can sharethe world and help them manageand learn. The fact is much in-cidental leaming is precludedwhen you don't see well. It is es-sential that individuals with VI beable o ask questions and com-municate feelings and thoughts.
Functional vision assessmentsand compensatory techniques andstrategies for visual impairmentsare critical to AAC practice. Anindividual's body, eyes and mindaffect what is seen. So does theoosition of the individual in the en-vironment. Mobility factors, light-ing level and the skills of com-munication partners also affectcommunication. Assessment ofthe visual system in persons withmultiple hand icaps, esBgciallychildren. mav include:'"
eve examination bv a develop-niental/behavioral bplometriSt.interviews with caregivers.
r observations of daily activities(e.g., watch for dec-reased bodydlifrineqt, fgtig .ue afte4 work-,rng on vrsual tasKsr ano so on.,
r consultation with other mem-bers of AAC team.
r use of a assessment toolsdeveloped for persons with murtiple. hindicape or youngchrldretr.
Dr. Hyvarinen, an ophftal-mologist ftom Finland hasdeveloped materials to assist in theassessment of vision. AmgpS hekits that are available are:"
r a discrete symbol set (apple,circle, square, house-2 and 3dimentional options) and prctocolsto train. llots; a variety ofresponse modes are avaihble.
r Frmctionrl acuity te,st.r Binocular test.r Color bst.r heferred looking pro,Bcol.Ba$tone and Harris" Presented
assessment suggestions for usewidr children with severe cornmun-ication and visual impairments. Aprotocol called 'Assessing thefunctional vision of people withsevere and multiple disabilitieslconsiders dre foliowing areas: to
! Body. Gross motor, indwendentmobility, arm/hand imction andeyes (reflexes, refraction, acuity,symrneky, visual perception,visual noise tolerance, visualabstraction and use of vision.)
r trlurnination. Position and t}?e oflight source in the environment,on materials and on a communica-tion drsplay.
r Contrast. Figure/ground charac'teristics are very important to filac-tional vision. The size. color andcomplexity of inforrnation in the'figure" and in the backgrouddetermine the degree of conhast.
r Size. Just making somethinglarger does not necessarily make itssier to see. Size characteristicsshould depend upon the charac-teristics of the stimuli as well asthe nahrre of a person's VI.
r Distance. The distance ofa per-son from tlre visual target will af-fect acuity. Please noie: Harrisuses a simulator trat allo\}s him !o
get an idea g$ut how a personsees things."'
r Verbal formulas. The way youtalk to a person is important.When providing choices, presentthe task in the same format, givethe penon time and be predict-able. For example: I 's tirne for abrealc, Here b your czp. [Moveit slowly across the person'sviwal field.f Here is yoursweqter. ll\fiove it slowly acrossthe visual field.l Now, I'm goingto show than both to you ltxtkat/touch the one you wqnt.
Another valuable assessmenttool with an AAC perspective isdre'SAAT-Systematic Assess-ment of Assistive Technology, "which is available ftom Bristow &Pickering. See Resources.
Teaching individuals with YIwill be more effective if you:
r involve their hands wi6 com-munication rnedia.
r pair symbols with soud.r use familiar nredia in familiar ac-
tivities so context cues may beused,
r base communication trainingwithin an individuals most lfamiliar activities. rL
t
t
RESOURCE CENTERSThe best are in your citv, town orregion. Below aie som6 examples ofnalional resources in the U.S.-Manyhave links with other'centers withiiand outside the U.S.
American Foundation for theBlind, National Technology Centet,15 W. l6th st.. New Yorl, NY10011. (202) 620-2080.
Carroll Center for the Blind, 770Centre St., Newton, MA @158.(617) 969-62W.
Foundation for Technology Access.2173 E. Francisco Blvd.. Sie. L. SanRafael, CA 94901. (415) 4554575.
Nationally Association for VisuallyHandicapped, 22 W. 21st St., NewYork, NY 10010. (zLZ) 889-3141.
National Iederation of the Blind(NFB), 1800 Johnson St., Baltimore,MD 21230. (410) 659-9314.
for someone who has VI. it is cru-cial to find ways to help the per-son receive information and learn.as well as communicate witho6ers. This section focuses on tac-tile, auditory ard visual symbolsand devices specifically designedto assist people with low visionand blindness.
SymbolsSome pmple with low vision
who don't speak can use print(i.e., text and/or gaphic sym-bols.) Many ofters, includingthose who are blind, must dependupon tactile and audimry symbolsto develop and use language.Table tr summarizes symbol op-tions for AAC users who areblind or visually impaired.
Tactile symbolsr Tangible. Texnred symbols, real
objects or parts of objects can beused with very yormg children andthose who have severe cognitive andlanguage impairrents.'Synbols"thal become relevant and meaning-frrl provide individuals with accessto language. Only then can they beused to make requests, comneDtand so on. Tactile symbols are mosteasily used one at a time, but can be
placed on low tech displays,switches and AAC devices. Fewusers with severe motor fupair-mnts are be able to communicateindependently using tactile symbols(tangible or Braille.)
r Braille: A tactile symbol system forrcading and writing used by a smallpercentag€ of persons who areblind. Many comtries have adaptedBraille to suit their language andcultural pattems. Braille cbaractersare formed using combinations ofsix embossed (raised) dots arrangedin two vertical columns-tbree dotsin each. Each character
sent a letter, a part or an entire wordor concept. Symbols exist for musicnotations (Music Braille code),arithmetic and mathermtical com-putations (Nemeth code) and scien-tific notions and computer com-rmuds (computer code.) Table Itrlisb products that allow individualsaccess to Braille materials.
Audilory synbols. Morse cod€: An intemational
auditory (or tactile) code for read-ing and writing. It consists ofdotand dashes which represent let-ters, words, phrases, and more.Some AAC devices translateMorse code to text and speech.
t Speech. Speech and otherauditory stimuli play a very inpor-tant and powerfrrl role in leaming.Speech ouQut is also used toenable people to access writtenlanguage and graphics. Examplesare talking books, readingmachines, conputerized books
and screen reading programs.Talking watches and other con-sumer technologies are readilyavailable, For some AAC users,listener-assisted and machinegenerated auditory scenning maybe the only means of accessinglanguage.Speech output as a means ofex-pression is sometimes overlootedfor AAC users with VI betauseAAC devices do not easily accom-modate tactile symbols or largegraphic symbols. This is truly rm-fortuaate. How are people withlow vision or blindness who can
not speak supposed to interactwith children, get atlention andfirnction independendy in the com-munity or classroom withoutspeech outpug AAC devices arebeginning to offer feahre,s tbatwill accomrnodate visual deficits,such as auditory scanning,auditory fishing and color displayswith good rcsolution. In addition,digitized speech devices are lowcost. Finally, synthesized speechallows access !o computers andmay be the best way for many todevelop written and "spoken" lan-guage skills.
Visual symbolsr hint: The size, quality, contrast,
line thickness, color, affangerentand position of text and/or symbolscan b€ altered using both low andhigh tech solutions. Low visiondevices provide access !o printedmaterials mcler specifi c conditions.Exa ples are fihers, mngnifiers,
Newssrmglasses, large phone dials, spe-cial light pens, telescopes andtelemicroscopes. Screen enlargers,closed circuit TVs, and optical char-acler readers enable people with lowvision to "see" print.
Table trI gives a few examplesof currendy available devices forpersons with VI or blindness, in-clvdng some braille prduas and
low tech visual aids.zo Screenreoders trafislate text and somegraphics on computer displays tospeeoh. Closed circuit TVs and,screen enlargers provide mag-nifi cation to enlarge print/symbolsand enhance figure-gtound con-tasts. Optical character recog-zzers translate printed materialinto an electronic format drat can
be stored and accessed via a com-puter monitor, printer, synthesizeror braille display. In selectingequipment consider accuracy,rate. comprehension, comfort andfatigue. Currently, many AACdevices do not interface easilywith devices designed o assistpeople witl M so check carefullywith manufacturers ! {
ScrecnPowerT.l.66.rt Corpor.lbn
Combinntion hardware and soft'rare enhancenpr'l forIBM compatibles in DOS environment. High quttyspeech. can work with 40 cell FowerBraille forsimullaneous braille snd spee.h outsut.
Close Vb{ &EZ Access
Apple Cooputar,Inc.
Maanification sofiware (2x-16x) included inMacintosh systems. Access through control ps$el.Offers reverse polarity. Ez-Access is for perlonswith physical disabilities.
Sound-PrmfIBM comprtibles in Ms Dos environrnent.Highlights each word as spoken with Keynole GOLDspeech synthesizer. works wilh siandffd softwarc.HelDs individuals with learnine disabilides
inlarge 2.0Magnifies everyrhina @x-l6x) on €ntire screan or Aportion. Can select automatic scanniru st variablespeeds, reverse polarity. Wofks wirh oUISPOKEN.
oUtSPOKEN(PC and Maciniosh)
Dsk l.t Sy.tan., IrE
Full screen access to most text-based prqFams.Reads letters, words, lines, menus, icons, wirdows.Available for Macintosh snd rc (widows). can b€combined with inl3rge for screen enlargernent.
MagricamPortable hand-held camera lhat att&ches !o a standardtelevision set or small porable TV.
Window Brilge screen .eading program for windows. Re{ds icons aswell as text.
See-PC VisimS.dry Tehmb8lq,IE
Csn connect IBM compatibles and VGA monitor
WordScholarDeveloped for persons with learning disabiliues.simullrneous word highlighting ss the screen is.e3d.
ValrtageChmrua CCD
Td.Ado.y Corym|lon
Closed circuit TV wilh a solid-state CcD camem.Magnifies 3x - 45x. can also be used wilh vIsTAVGA as a split/screen computer magnification sysem.
VISTA VGA'l'.l.SdD.y Co.pmltrn
IBM-compatible. Magnifies computer screen (3x -16x). Includes text and graphic magnifrcation. Ofrersreverse Dolarity. Has instant locator window.
OsCaRT.l.6aDrt Corpor.lbn
Characler recognition. Scans and converl6 prinldocuments on lBM-compatible computers. Readsdifferent fonts. Compatible with various accessdevices (|arge print, speech, elctroric/hard-copybraille.)
ZoomText PhsAi Squared
Software magnification program (lxSx) for IBMcompatibles (DOS and Windows). Works witlr wordprocessing, spreadsheet, and dalabase pmgrans. canselect color backgrourd.
Op€tr BookUDbound
Scans and converts prinl documents on IBMcompatibles, Once converted and esved, documentcan be brailled, read with a screen reader orrnaEnified with a text enlarsement Daosram.
Brailo'nSpeaksmall porlable braille notetaker. Braille to print ardspeech. Also hss noie organizer, cslculator, clock andcalendar. One serial oort.
Optacon trTd.6d-rl Corpdadon
Portsble device converling visual imsges on s pri edpsge !o tactile configurations via raised vibrating pirs.Hss mapnification lens oDtions and s seri{l Dort.
Eureka Small portable b.aille notebker. Irfortdion isentered by 6 keys corresponding to 6 bmile dots.
NolR & UVShlldFilters
Chemically absorb 100% of uhraviolet intared srdhaz{.dous blue rays. Different colors provide varyingdegress of light trsnsmission.
VersaPdtr.T.l.S.Mry Corpmdm
Produces braille documenls (Braill€ ernbosser).Coverst computer generated text to braille.
For address€d, pl€ese s€a lilt of manufac'trr€rs on paSe 8.Books, magazin€s,trewspapers on tapeor computer di*s
Audiocassettes. Check local resources. In lhe U.S.tle Library of congress, Braille Institul,e Library,Recordings for lhe Blind are good resortces.
6 .
UniversiW& Researih
RERC on Sensory aidsat S mith-Kettlewell
I he Smith-Kettlewell Eye Research Instirute is lo-cated in San Francisco. The Rehabiliation EngineeringResearch Center G.ERC) for Sensory Aids, funded bythe National Institute for Disability and RehabilitationResearch (NIDRR), is part of the Eye Research In-stiurte. Among tre projects they have worked on are:
. R€search And Developmq . A focus is on developingdevices for blind md deaf-blind children and adults:, Tacl lell le€ming syslem. Utilizes inleractive modular
peflpherals,whtch connect to an Apple computer aodspeecn synuresrzer.
- Flexi-Formboard. lmproves a child's skilt with
Eeokmetrical sbapes though audiiory and tactile feed-
- Dexter (robotlc land system). Forms manualIrngefspellng. }lacllltates teleplone commumcatton,race-ro-Iace communtcatton and computer access.
Products io assist persons with low vision include newmagnifier systems and illumination devices using fiber optics,metal halide and quarts halogen technologies for optimalviewing without rmwanted heat and glare.
Webster Sheet, San Francisco, CA 94115. (415) 561-1620.
RERC on Low Yision andBlindness,22
Proposed priorities for fimding ofthenext Rehabilitation Engineering Cen-ter on I-ow Vision and Blindness areto:
develop innovative adaptiveoevtces atrd enplneenng solu-tions to prepare 4l gbildr5n withlow uslotr ancl blrndness io enlerschool (i.e., early identificationand qloiritoring and treatment ofvrsual rmparrments m neonatesand rnfants. )improve visual displavs includ-ing flat panel displa'vs furd lisuidcrlstal tlisplays'with low cbn-rast.maintain access !o new Drodrctsused in the home, workp'lace andcommunitv such as sblid state{isnlayq, ligypads. and compactqrsc recnnology.
- conduct research on theDrovision of access to oublicfacilities and mss transit.'
- develop techniques to increaseindepdndent i rob i l i t v anddecrr5ase dependence on'othersrot rnrormatton and assrshnce.
- conduct research. develoo andevaluate new and adaptiyd tech-nology lor persons ivith deaf-
,.. *"li'lffi,"' "b*r NDRR +programs and publications, write: NIDRR,Room 3424, Dept. ofEduc., 4008 MaryladAve. SW, Washington, DC 20202.
GovernmentalGroups solving
problemsYl-.ea Hlvarinen, an ophtlal-
mologist from Finland whosework is widely known andrespected, feels governrnents arein the best position to support theformation of interdisciplinary$oups that enable busy prac-titioners to brainstorm tooics andmake headway in a field3 A fewexamples follow:l! Nordic Countrie .22
Sweden, Norway, Denrnark, Finlandand Iceland have a long tradition ofworking together. This October asmall group of ophthalmologisb andco-workers are planning a seminar inOslo, Norway to discuss ways to im-prove the assessrnent of children andadr ts who bave visual inrpairmenband problems commrmicating. Par-ticipants at the upcoming meeting willinclude ophthalmologists,psychologists, neuropsychologists,pediatric neurologists, occupational0rcrapists, physiotberapists and con-
munication specialists. The group willdiscuss better ways to assess the ftrnc-tional vision available for commrurica-hon,
E Cons"nsus Conference onProtocols for ql,roosing lowYrsron oeYrc€s.z,
In 193 a panel sponsored in the U.S.by the NIDRR developed a consensusstatement and a publication inresponse to the following questions:
- What clinical measurements andfunctional behaviors define thepoDulation of adults who canberiefit from low vision devicas?
- What are the best standard clini-cal and functional assessmentpraclices .addressing the needs ofaoul6 wlrn low vrslonlWlat are the optical-functionalcharacteristics bf available lowvision devices that meet theneeds of adults with low vision?What are the best oractices fordetermining which lqy visionoevtces w l be most eltectlve rnmaximizing visual function foradults wittilow vision?
- What instruction and suidedpractice currentlv best insuresiuccess fu l u t i l i za t ion o fdevices?
- What future research is needed?
Products tc address employment needs of persons withblindness include:
- Flexi-Meter. A computerized "universal* iob in-stru_mentation system aDd a new speech moclule foradaptrDg rneasurrllg rnstrumeDts.a computer access system using a touchpad !o reDre-sent the coDputer sdreen and a=speech s'ynthesizdr tospeaK rne contents ot the scre€o at urat posrtton.a pocket-sized electronic braille notetaker.
- a low-cost refreshable compuler braille display.auditory instruments to facilitate the interconnectionol computers and peripherals by blind operators.
r Information dissemirmliclit Thz Smith-KealcwellTechnical Filc is a t*htlucal zubscription magazine forthe blind and visual imnaired.
r Clinical Services. A collaborative arranperent with theCalifomia Pacific Medical Center's l-oriVision Servicesallows the development of cusromized aids requested byindividuals and/or their rehabilitation cormselors. smallscale production and sale of lirnited-narket sensory aids,custom software and computer interfacing modifications,expert consultation on job site modifications and opera-tion ofan ele{tronics training program for the btind.Finally, the RERC on sensory aids is developing and te,st-rng Dew assessment techniques. par.ticularly for the earlydetection ofvision disorders.
CFor sdditiorul information conhct Smirh-KettlewetlEyetnsjltt, 2:232
. REFERENCES' Blackstone, S. (1988). Dual-sen-sory impairments and AAC. AcN,l:4-. 1-8.
' Geneskv. S. as quoted in theReport of the nati6nal adv-isory e
olan:1944- lqq8, Washington: NIH-National Eve Institute. 305.
o Cress, P., Spellman, C., DeBri-ere, T., Sizeniore, A., Nortlam, J,,& Johnson, J. (1981). Vision screen-ine for D€rsons with severe hand-icips, Jirurnal of the assrriation fo'the severelv hgndicanned. 6(3), 41-50.7 Utley, B.L. (1994) Providing sup-port lor sensory, postural anc mole-
" Jean Prickett. (September, 1994).Personal communication.
13 Rowland, C. (1990). Communica-tion in the classrbom for chi.ldrenwith dual sensorv imosirments:Studies of teach6r at'd child bahavior. AAC. 6:4, 262-n6.
la Thodev. B.. Ward. J.. Binepal.T. & Dolln, K. (1991). Comm'uni-catins with Drinted words to aus-mentiisnils: Case shrdy ofa sEvere-lv disab-led deaf-blhd ctii.ld. AAc.7:2, 80-87.
inen!. (and other -publications
airdmaterials availabfe from Vision As-sociates. 7512 Dr. Phillips Blvd 5G150. Oriando. FL 32819'or fromLea Hwarinen, M.D. Harmaapar-rankuia 3. FIN-02200 ESPOOIin-land. FAX 358-04208968.)16 H".rir, G., Batstone, S., and Har-muth. P, Oh. sav. can vou see?Papei presented'ai the ISAAC BieFnia-l Conference. Stockholn,Sweden. August, 1990.17 B"t"ton", S. & Harris, G. (1990)Ouestions regardins $e fimctionalv-ision of oeoile wiih multiple dis-abilities riith'reference to cbm-munication needs. Available fromArbutus Societv for Children, 2400Arbutus Rd, Victoria, BC, Cinadav8N 1V7
l9 Brirto*, D. & Pickering, G. (nreview for publication). Overviewof assistive'technolosi. In Deutsch,ot asslstrve technology. ln ueuscnP.M. & Sawyer, H.W. (Eds.) Asuide to reha-bilitation (Vol. 1) andnamases in Tort Actions (Vol. 9).
119-154.nlan: I oa4-l498, Washington: NIH-Natiotral EYe Institute. 305.
corincil. Yisi
e Lambert, S., Hoyt, C., Jan, J.,Barkovich. J. & Flodmark, O.(1987). Visual recovery fiomiwoiic cortical blindriess durinec[itOtrooa. Archives of onhthalriol-ogy. 105: 13? l-1377.lo Groenveld, M. Jan, J., & I-earler,P. (f990). Observations on thehabilitation of children with corticalvisual impsiment. Journal of visualimnairment and blindness, 11-15.
Matthew Bender & Co., Inc.20 Lea Hwarinen (seDlember,1994). P6rsonat c<imrirunication.
22 Federal Resisier (Ausust 25,19eqs2:r62.-
+' -
P.o.Box 669, Mancheser
109014 Rooseveli Blvd.,f200, st. Pe&rsburg, FL33716.
7074 Brooklyn Blvd.,Minneapolis, MN 55429.
Kurzweil Pe.sonal Re{derhoducls, Cent€rmhl Dr.
" Hoon. A. (199t). Visual innair-ments in childrei with develdomen-tal disabillies. Iq A. Caput€ &_P,- strategies. Austir, TX: ProEd.
