Chapter 5
Assistive Technology for Students
with Visual Impairments and Blindness
Austin M. Mulloy, Cindy Gevarter, Megan Hopkins,
Kevin S. Sutherland and Sathiyaprakash T. Ramdoss
Introduction
The use of assistive technology (AT) with students with visual impairments (VI)
and blindness has the potential to improve many student outcomes related to
academics and learning (e.g., Bouck et al. 2011; Bowers et al. 2001; Ferrell 2006;
Lovie-Kitchin et al. 2001; Spindler 2006; Theoret et al. 2004). Impairments in
vision render students with VI and blindness frequently unable to make use of many
common objects in schools, such as written instructional materials and computer
screens. These impairments also restrict incidental learning opportunities that
typically developing students access visually, such as observing others’ skill
demonstrations and witnessing examples of functional relationships (Hyvarinen
2000). Assistive technologies provide students with VI and blindness access to
many school-related activities by enhancing existing sight abilities or drawing on
other senses (e.g., hearing) and abilities (e.g., oral language).
A. M. Mulloy (&)
Department of Educational Psychology Counseling, and Special Education,
The Pennsylvania State University, 125D CEDAR Building, University Park,
PA 16802, USA
e-mail: austin.mulloy@psu.edu
C. Gevarter
Department of Special Education, The University of Texas at Austin, Austin, TX, USA
M. Hopkins
Department of Curriculum and Instruction, The Pennsylvania State University,
University Park, PA, USA
K. S. Sutherland
Department of Special Education and Disability Policy, School of Education,
Virginia Commonwealth University, Richmond, VA, USA
S. T. Ramdoss
Department of Special Education and Communication Disorders,
New Mexico State University, Las Cruces, NM, USA
G. E. Lancioni and N. N. Singh (eds.), Assistive Technologies for People with Diverse
Abilities, Autism and Child Psychopathology Series, DOI: 10.1007/978-1-4899-8029-8_5,
Springer Science+Business Media New York 2014
113
This chapter strives to provide examples, explanations, research findings, and
implications for use of AT with students with VI and blindness. First, we discuss
various definitions of VI and blindness, prevalence of the impairments, common
challenges associated with VI and blindness, and the process of fitting AT to
students. We then focus on explanations and research findings on AT-relevant
assessments of VI and blindness, and AT for pre-academic learning, reading,
writing, mathematics, and science students. For each domain of learning, discussions
of AT items are grouped according to whether the AT enhances the sight
capabilities of users or engages senses and abilities other than sight. Last, we
conclude by addressing a number of clinical and academic implications of use of
AT with students with VI and blindness, including implications related to
assessment, AT selection, teaching and encouraging use of AT, technology
abandonment, and future research.
Definitions of Visual Impairment and Blindness
Several different perspectives on VI and blindness have given rise to multiple
definitions and conceptualizations of the impairments. These include (a) a focus on
the anatomy and etiology of impairments; (b) an emphasis of a person’s visual
acuity and visual field; and (c) attention to the functional capabilities and
limitations of a person’s vision. Each approach to defining an impairment is
relevant to designing and evaluating AT supports for students with VI and
blindness; however, definitions related to visual acuity, visual field, and functional
limitations are often most useful to the work of educators (Faye 1996; Individuals
with Disabilities Education Improvement Act of 2004 [IDEA] 2004b).
Anatomic and etiological definitions. The medical community has identified a
wide variety of disease conditions and anatomical anomalies that lead to VI and
blindness (American Foundation for the Blind [AFB] 2013a). These conditions
and anomalies can be congenital, meaning they are present at or near the time of a
person’s birth, or adventitious, meaning they were acquired after birth, during
childhood, or some point later. Some of the most common disease conditions and
anatomical anomalies include:
1. cortical visual impairment—damage to the visual cortex, temporal lobes, and/or
parietal lobes of the brain (e.g., by oxygen deprivation or infections of the
central nervous system) which disrupts the receiving and decoding of information
sent by the eyes;
2. retinopathy of prematurity—damage to the retina by blood vessel overgrowth
and the resulting scar tissue which is associated with premature birth;
3. optic nerve hypoplasia—underdevelopment of the optic nerve, that transmits
information to the brain, and possibly midline structures in the brain;
114 A. M. Mulloy et al.
4. strabismus—misalignment of the eyes resulting from abnormal development of
eye muscles, nerves which supply the eye muscles, or brain regions controlling
eye movement;
5. amblyopia—regression in the function of an eye due to chronic obstruction of
vision in the eye, strabismus, or refractive differences between the two eyes;
6. nystagmus—a rapid jiggling back and forth of the eyes that interrupts fixation
on objects and which results from underdevelopment of the optic nerve or
fovea, or a variety of rod or cone abnormalities (Hatton 2001).
In addition to these conditions and anomalies, VI and blindness can also result
as collateral outcomes of traumatic brain injury, severe eye infections, tumors, and
diabetes (Geddie et al. 2013).
As mentioned above, the anatomic and etiological factors involved in a person’s
visual impairment often have little relevance to the design and evaluation of AT
supports for students with VI and blindness. The cause of visual loss frequently
does not provide information on the residual vision possessed by a person or her
ability to make use of vision in functional tasks (Hyvarinen 2000). Further,
research has shown that the cause of visual loss is not associated with the degree of
delay in developmental milestone acquisitions (Frailberg 1977). However,
understanding the anatomic and etiological factors involved in a person’s visual
impairment can be critically important to the success of treatment initiated by
ophthalmologists, optometrists, and neurologists (Matta et al. 2010).
Visual acuity- and visual field-based definitions. The terms low vision and
legally blind are based on measurements of a person’s visual acuity and visual
field. Visual acuity is an index of the sharpness or clearness of vision (Cline et al.
1997), and is measured by requiring a person to identify symbols on a chart at a
distance. The likely familiar 20/20 rating represents nominal vision. A rating of
20/40 implies a person, when at a distance of 20 feet, can identify symbols that a
person with nominal vision can identify at a distance of 40 feet. Visual field is the
scope of vision (Geddie et al. 2013). Testing of visual field includes measuring the
range of a person’s central and peripheral visual fields, and results in identification
of scotomas (i.e., areas of partially or entirely diminished visual acuity). Normal
visual fields are defined as extending roughly 60 toward the nose, 100 away from
the nose, 60 upward, and 70 downward (Spector 1990). Individuals are identified
as having low vision when they have visual acuity of 20/70 to 20/200 in the better
eye after correction (i.e., with eyeglasses or contacts) or a visual field limited to
20–40 after correction (Brilliant 1999). Legal blindness is typically defined as
visual acuity of less than 20/200 in the better eye after correction or a visual field
limited to less than 20 (Koestler 2004). It’s important to note that legal blindness
differs from common conceptions of blindness (Huebner 2000). Whereas individuals
with legal blindness may have some functional residual vision, individuals
identified as blind have either no vision or only the ability to perceive the presence
of light.
While use of the labels low vision, legally blind, and blind don’t necessarily aid
the design and evaluation of AT supports for students with VI and blindness,
5 Assistive Technology for Students with Visual Impairments and Blindness 115
knowledge of a person’s visual acuity, visual field, and extent of light perception
can. Generally, when considering a student’s ability to perform specific tasks,
information regarding visual acuity, visual field, and light perception guides
selection of supports for use of residual vision and/or suggests utilization of
supports that engage a student’s other senses and abilities. The use of information
on visual acuity, visual field, and light perception is discussed further throughout
the chapter.
Functional categories of visual impairments. Vision impairment can also be
conceptualized in terms of functional effects of the involved eye disorder(s) and
severity of the impairment. The most useful information for the design and
evaluation of AT supports for students with VI and blindness derives from
descriptions of the functional effects of eye disorders (Faye 1984, 1996; Hyvarinen
2000; Topor and Erin 2000).
Functional effects of eye disorders. The effects of eye disorders fall into three
categories: media pathologies, central visual field defects, and constricted fields or
peripheral scotomas (Faye 1984, 1996). Media pathologies produce blurred or hazy
vision, reduced contrast sensitivity, and, possibly, increased experience of glare.
These effects result from diseases and anatomical anomalies (e.g., cataracts) that
affect the optical media (i.e., cornea, pupil, lens, and vitreous). Supports for students
with media pathologies should emphasize refraction (e.g., via eyeglasses),
control of illumination, and enhancement of contrast. Central visual field defects
reduce perception of details and color in the direct line of sight, both at close and far
distances. Such defects result from diseases and anatomical anomalies that affect
the cone-bearing fovea and macular area of the eyes. Supports for students with
central field defects should draw on and maximize peripheral vision through
magnification and enhancement of contrast. Constricted fields, or peripheral scotomas,
reduce perception of details and color outside the direct line of sight.
Notably, constricted fields interfere with orientation in space and cause difficulty in
locating objects. When the degree of field constriction is great (i.e., vision is constricted
to the cones in the center of the eye), night blindness can result. Such
functional effects result from a variety of conditions, such as glaucoma, head
trauma, stroke, and retinitis pegmentosa. Supports for students with constricted
fields should emphasize magnification and address orientation and mobility needs.
Severity of impairment. Visual impairments are often classified as mild,
moderate, severe, or profound; however, no criteria have been put forward for
objectively delineating these categories (Bergwerk 2011; Friend 2011). Students
with low vision are often considered to have mild to moderate VI. Impairments
which qualify as legal blindness can range from moderate to profound, while
blindness unarguably constitutes a profound VI. When planning supports for
students with VI and blindness, the relative emphasis of AT that enhances vision
and AT that draws on other senses and abilities should be in accord with the
severity of the student’s impairments.
116 A. M. Mulloy et al.
Prevalence of Visual Impairments and Blindness
The prevalence of VI and blindness is estimated at 1 to 5 % of the population
(American Academy of Ophthalmology 2002; Mason et al. 2000; Multi-ethnic
Pediatric Eye Disease Study Group 2008). The prevalence varies across countries
and is generally greater in developing countries, where nutritional disorders (e.g.,
vitamin A deficiencies) and infections (e.g., trachoma, measles) are common
(Geddie et al. 2013). In the United States, determining the actual prevalence is
problematic because no comprehensive registry exists and the different databases
define VI differently and focus on limited age ranges (Kirchner and Diamant 1999;
Mason et al. 2000). For example, the United States Department of Education
maintains counts of the number of students who receive special education services
by disability category. Students who have multiple disabilities (e.g., blindness and
intellectual disability) are counted only once (e.g., as having a VI, an intellectual
disability, or multiple disabilities). Students with VI are presumably often counted
in categories other than VI, at unknown relative rates. This is particularly problematic
for estimating prevalence because between one-third of children with some
residual vision and two-thirds of children with blindness have one or more additional
disabilities (Kirchner and Diamant 1999; Mervis et al. 2000).
Challenges Associated with Visual Impairments
and Blindness
Visual impairments and blindness pose a number of developmental challenges to
affected children. The conditions can detrimentally influence physical, cognitive,
linguistic, social, and academic development, as well as contribute to the development
of problem behaviors (Baillargeon 1993; Bergwerk 2011; Brodsky 2010;
Fazzi et al. 1999; Houwen et al. 2010; Hyvarinen 2000; Perez-Pereira and ContiRamsden
1999). A variety of factors appear to moderate the effects of VI and
blindness on an individual’s developmental outcomes. These include the amount
of residual vision, the presence and severity of other disability conditions, the
overall health of the individual, the amount of support provided to and accepted by
the individual, the quality of support provided by teachers, therapists, and parents,
and the educational attainment and occupational choices of the individual
(Davidson and Quinn 2011; Frailberg 1977; Hatton et al. 1997). Theoretically, by
extension, provision of AT supports seems likely to improve students’ developmental
outcomes.
Challenges to physical development. With regard to physical development,
impairments in vision can hinder learning of oculomotor and other motor skills
(Bergwerk 2011; Brodsky 2010; Frailberg 1977; Hyvarinen 2000). For example,
increases in falling and timidity, especially in new environments, and delays in
development of balance, posture, and self-initiated mobility have been observed in
5 Assistive Technology for Students with Visual Impairments and Blindness 117
infants and toddlers with VI and blindness. Also, many motor skills are typically
learned incidentally, via modeling (Brodsky 2010; Hyvarinen 2000). Children with
VI and blindness often are unable to utilize such skill demonstrations. Support for
development of motor skills in children with VI and blindness is especially
important, as decreased motor development in the population is associated with
lower levels of physical fitness and higher rates of obesity (Houwen et al. 2010).
Challenges to cognitive development. Children with VI and blindness
often experience delayed development of cognition related to spatial concepts
(Baillargeon 1993; Hyvarinen 2000). During infancy, children typically develop
depth perception and understandings of ego-centric space and object permanence
while manipulating objects with their hands and watching the effects of their
movements. While many opportunities exist for children with VI and blindness to
learn spatial concepts, implementation of supports for early learning is crucial for
preventing delays in their cognitive development.
Challenges to linguistic development. Impairments of vision can disrupt and
delay the development of preverbal, verbal, and nonverbal language (Brodsky
2010; Perez-Pereira and Conti-Ramsden 1999). The learning of preverbal and
nonverbal communication typically involves observation and imitation of others’
movements (e.g., of the lips or head). Linguistic development in children with VI
and blindness is often instead driven by the sense of hearing. Research has shown
that children with VI and blindness use less body and facial language, have
difficulty with pragmatics and pronouns (e.g., incorrectly say ‘‘you’’ for ‘‘I’’), and
have less developed conversation skills (Perez-Pereira and Conti-Ramsden 1999).
However, children with VI and blindness who have average intelligence or greater
often attain typical levels of verbal language proficiency by mid-childhood.
Challenges to social development. With regard to social development, VI and
blindness can negatively impact bonding, attachment, and social interaction
(Brodsky 2010; Hyvarinen 2000). Much of the bonding and attachment of infants
with caregivers is facilitated by eye contact. Similarly, eye contact and vision are
central to social interaction and the development of social skills. For example, in a
case study of an infant with VI who was delayed in development of social
interaction, the provision of eyeglasses immediately resulted in first an expression
of surprise, and then a social smile coupled with eye contact (Schwartz et al.
1997). Based on the infant’s previous failures to engage socially, the medical
professionals working with her had formed the hypothesis that she had an autism
spectrum disorder. The results of provision of eyeglasses, however, revealed that
the infant’s inability to perceive faces had prevented her from developing
age-appropriate social behaviors.
Risk of problem behavior. Students with VI and blindness, like many other
individuals with disabilities, are at risk for developing problem behaviors (e.g.,
Conley and Worley 1980; Lalli et al. 1996). For example, children who have
impaired night vision may cope with a fear of the dark or inability to navigate
independently with behaviors, such as tantruming or screaming, that function to
enable their escape from the overwhelming challenges or otherwise aversive
stimuli via recruitment of caregivers’ assistance (Bergwerk 2011). Individuals with
118 A. M. Mulloy et al.
VI and blindness may also develop atypical self-stimulatory behaviors (e.g.,
pressing on eyes, waving fingers in front of eyes; Fazzi et al. 1999) or problem
behaviors that function to provide access to objects or the attention of others they
have difficulty locating or reaching. Such problem behaviors can be successfully
extinguished and replaced with functionally-equivalent positive behaviors through
behavioral intervention (Alberto and Troutman 2012).
Challenges to academic development. Vision impairments and blindness have
the potential to disrupt students’ academic learning in traditional, mainstream
educational settings. In the past two centuries, many instructional strategies and
materials, as well as assistive technologies, have been developed for enabling the
learning of students with VI and blindness (Friend 2011). While some students still
encounter learning and performance barriers (e.g., in advanced chemistry courses;
Supalo et al. 2006), the numbers of these barriers are progressively decreasing with
time.
Early detection and intervention with children with VI and blindness is crucial
to maximizing their potential for vision and improving their developmental
trajectory (Mills 1999; Oldham and Steiner 2010). The current consensus in the
medical community is that children pass through a critical period of visual
development, lasting from birth to age 6, after which learning of vision skills
occurs much less efficiently and the physiological processes of development slow
or halt (Groenendaal and Van Hof-Van Duin 1992; Tavernier 1993). Research on
early intervention programs corroborates this view; findings suggest treatment
success is inversely related to children’s age at the time of enrollment (Mills
1999).
Overview of the Process of Fitting Assistive Technologies
to Students with Visual Impairments and Blindness
The goals of implementing AT with students with VI and blindness are to increase
or improve their functional capabilities, support their education and development,
and facilitate their independence (Desch 2013; IDEA 2004c; Sadao and Robinson
2010). Professionals in the field of AT assert these goals can best be achieved by
engagement in a standard sequence of procedures for fitting AT to students (e.g.,
Bryant and Bryant 2003; Cook and Hussey 2002). The process should begin with
assessments of the student’s skills and abilities, functional limitations, and learning
needs, as well as task analyses of activities for which they will receive support.
The resulting information should then be used to select AT devices that draw on
the student’s existing skills and abilities, improve their functional capabilities, and
enable their full participation in target activities. When implementing the selected
AT, professionals should consult the research literature to identify AT that has the
greatest likelihood of effectiveness, take care to obtain the buy-in of the students
regarding the AT, confirm use of the AT is convenient and effective, and provide
5 Assistive Technology for Students with Visual Impairments and Blindness 119
training to the student and others who may support his use of the AT. Finally,
periodic and/or on-going evaluations should be carried out regarding the success of
implementation of the AT, the device’s state of repair, and the goodness of fit
among the student’s learning needs, skills, functional limitations, and activities for
which she needs support. Issues related to assessment, decision making regarding
AT, teaching and encouraging use of AT, and evaluation of AT supports are
discussed further throughout the chapter.
Research Review
In this section, we provide explanations and research findings on AT-relevant
assessments of VI and blindness and AT for pre-academic learning and reading,
writing, mathematics, and science students. For each domain of learning, discussions
of AT items are grouped according to whether the AT enhances the sight
capabilities of users or engages senses and abilities other than sight.
For some AT items discussed below, little or no research has been conducted
to investigate or comparatively evaluate devices’ effectiveness in improving
individual’s functional capabilities. Instead, the intuitive appeal of the AT and
anecdotes of improved functioning with use of the devices have led to their
widespread acceptance and promotion (Hyvarinen 2000). For items for which no
research has been conducted, discussion is limited to description of their features
and explanation of their potential uses.
Assessment
The extent and quality of assessment are critical determinants of long-term AT
implementation outcomes of students with VI and blindness (Day et al. 2001).
Research has shown that when one’s needs were not fully identified and addressed
during the AT assessment and selection process, dissatisfaction with and abandonment
of AT are likely (Cook 1982; Zola 1982). To comprehensively document
the support needs of students with VI and blindness, and improve the likelihood of
student satisfaction and implementation success, professionals from several disciplines
conduct assessments of students’ visual acuity, visual field, functional use
of vision, and preferences for learning media (Faye 1996, 1984; Hyvarinen 2000;
Topor and Erin 2000). Results of the assessments are used in planning AT supports,
as well as related services, school-based accommodations and curriculum
modifications (Friend 2011).
Visual acuity and visual field assessments. As mentioned above, assessment
of visual acuity involves requests to identify symbols on a chart at a distance and
determines the sharpness or clearness of an individual’s vision (Cline et al. 1997).
Assessment of visual field involves requests to identify the location of objects in
120 A. M. Mulloy et al.
central and peripheral visual fields, and results in identification of scotomas (i.e.,
areas of partially or entirely diminished visual acuity; Geddie et al. 2013). These
types of assessment are performed by medical professionals such as primary care
physicians, pediatric neurologists, ophthalmologists, and optometrists. These
professionals, as well as certified low vision specialists and teachers of students
with VI, use the resulting information to select optical aids to support individuals’
use of their residual vision (e.g., eyeglasses, telescopes, closed-circuit television
[CCTV]; Faye 1996, 1984; Hyvarinen 2000), plan environmental arrangements
(e.g., classroom seating; IRIS Center for Teaching Enhancements 2012), and
identify skills for instruction (e.g., how to hold materials at appropriate distances
or locations in the visual field; Topor and Erin 2000). To ensure validity of results,
professionals who assess students’ visual acuity and visual field should use ageand
ability-appropriate assessment procedures (Bergwerk 2011; Chou et al. 2011;
Committee on Practice and Ambulatory Medicine Section on Ophthalmology,
American Association of Certified Orthoptists, American Association for Pediatric
Ophthalmology and Strabismus, and American Academy of Ophthalmology 2003;
Geddie et al. 2013; Hyvarinen 2000; Topor and Erin 2000; US Preventative Task
Force 2011; Utely et al. 1983). For example, consideration should be given to
(a) individuals’ capacity for cooperation, (b) recognition of symbols, (c) communication
of visual experiences, as well as (d) the maturity of the visual system,
(e) development of visual behavior (e.g., preferential looking, eye contact), and
(f) possible effects of comorbid disabilities. The literature suggests a variety of
strategies for addressing challenges to assessment, including (a) use of nonconventional
symbols recognized by and meaningful to the student, (b) establishment
of fluency with or creation of names for symbols prior to assessment, (c) use of
single symbol cards, (d) prompting of alternative responses such as yes/no,
gestures, and eye-blinks, (e) engagement of students in interactive tasks (e.g.,
activating lights in the visual field), (f) assessment of vision in nonconventional,
familiar, and/or preferred environments (e.g., a plastic ball pool), (g) segmentation
of assessment into a series of short sessions, and (h) use of vision screening
technologies (e.g., electroretinogram, electrooculogram, magnetic resonance
imaging).
Functional vision assessment. Functional vision assessment evaluates how a
student uses vision to complete functional tasks and determines the extent to which
the visual disability affects learning (Corn and Webne 2001; Erin 1996; Hyvarinen
2000; Topor and Erin 2000). These assessments are typically performed by
teachers of students with VI, who use the results to formulate plans for AT,
specialized instruction, and environmental adaptations that increase the efficiency
of a student’s visual functioning. On occasion, functional vision assessments also
uncover needs for additional evaluation(s) related to vision or other functional
domains. Of primary interest in the assessment are the questions: (a) what is the
range of a student’s visual functioning across various lighting, contrast, and color
conditions, levels of motivation, and durations of activity?; (b) how does the
student function in developmentally appropriate functional tasks and typical, agespecific
classroom environments?; and (c) what visual information will need to be
5 Assistive Technology for Students with Visual Impairments and Blindness 121
compensated for by other modalities? In answering these questions the assessor
identifies specific tasks, circumstances, and sensory input for which the student
needs support in the form of AT, specialized instruction, and/or environmental
adaptations.
Since the environments and abilities of students with VI and blindness vary
greatly, no standardized functional vision assessments exist (Shaw et al. 2009).
Instead, professionals may use a variety of established instruments or self-developed
techniques which involve direct and/or indirect observation, and generate quantitative
and/or narrative format results (Bishop 2004; Erin and Paul 1996). While such
customization of the assessment process fits the diversity of student profiles and is
generally regarded as good practice, no research has investigated the reliability of
assessment findings across examiners or varying combinations of assessment
methods. As in assessments of visual acuity and visual field, use of age- and abilityappropriate
assessment procedures can improve the validity of results (Hyvarinen
2000; Topor and Erin 2000; Utely et al. 1983).
Several authors have published instruments for use in functional vision
assessments. These include the Individualized Systematic Assessment of Visual
Efficiency (ISAVE; Langley 1998), Functional Vision and Learning Media
Assessment (FVLMA; Burnett and Sanford 2008), and Cortical Visual Impairment
Range (CVI-Range; Roman-Lantzy 2007). Investigations of the methodological
properties of these instruments are limited to assessments of the reliability of the
CVI-Range. Newcombe (2010) found the assessment had high internal consistency,
test–retest reliability, and inter-rater reliability. When conducting functional
vision assessments, professionals may additionally find useful general functioning
assessments, such as the International Classification of Functioning, Disability and
Health (World Health Organization 2001), Functional Independence Measure for
Children (Wong et al. 2005), and the Pediatric Disability Inventory (Ostensjo et al.
2006).
Learning media assessment. Learning media assessment documents a student’s
preferred sensory channel(s) (i.e., vision, touch, or hearing) and facilitates
identification of optimal instructional materials (e.g., pictures, rulers, worksheets),
instructional methods (e.g., demonstration, modeling, prompting), and literacy
media (e.g., print, Braille) for the student (Koenig and Holbrook 1995). Documentation
of a student’s sensory channel preferences involves direct observation
of the student’s interactions with learning media in a variety of settings, recording
of observable behaviors, and notation of what sensory channels the student
appeared to use in performing the behavior. When data collection is complete,
observers make overall tallies of use of each sensory channel and attempt to
identify patterns between sensory channel use and features of the environments or
activities. Subsequently, the observers or other educational professionals who
work with the student peruse extensive lists of instructional materials, instructional
methods, and literacy media, organized by the sensory channels each engages, and
select media that match the student’s identified sensory preferences. Assessment is
often re-conducted periodically to determine the adequacy of the learning media
implemented with the student.
122 A. M. Mulloy et al.
Authors have published two learning media assessments: the Learning Media
Assessment of Students with Visual Impairments (Koenig and Holbrook 1995) and
the above-mentioned Functional Vision and Learning Media Assessment
(FVLMA; Burnett and Sanford 2008). Assessment materials for each include
extensive lists of learning media organized by the sensory channels engaged. The
methodological properties of the assessments have not been investigated; however,
each has been field tested and experts confirmed they have face validity (American
Print House for the Blind 2013; Koenig 1999).
Assistive Technologies for Pre-Academic Learning
As mentioned above, supporting the learning of young children with VI and
blindness can improve their academic and functional outcomes at later stages of
their education (Groenendaal and Van Hof-Van Duin 1992; Mills 1999; Oldham
and Steiner 2010; Tavernier 1993). Theoretically, the development of visual
behaviors, haptic awareness, and fine motor skills, and the use of residual vision in
play and social interaction enable the learning of more sophisticated and complex
functional behaviors and skills in subsequent years. Below, we describe technologies
that may support early learning in children with VI and blindness, and the
limited research that supports their use.
Technologies that Enhance Sight Capabilities
Toys and adapted play areas. The development of vision, visual behavior, and
proprioception in infants is facilitated by manipulation and attending to objects
and their hands (Baillargeon 1993; Hyvarinen 2000). Visual impairments may
interrupt these developments. To draw infants’ attention to objects and their hands,
and encourage use of their residual vision, authors have suggested provision of
toys that give off light or glow, are marked with bright colors, and/or produce
sound (Holbrook 2006; Hyvarinen 2000).
Facial treatments. The development of language in young infants appears to be
aided by watching and copying others’ lip and tongue movements (Baillargeon
1993; Hyvarinen 2000). Authors have suggested the use of make-up and lighting
may improve the ability of infants with VI to perceive others’ lip and tongue
movements (Holbrook 2006; Hyvarinen 2000). For example, lips can be outlined
with a brown contour pen and/or highlighted with lipstick, and light sources can be
directed at the face.
Electronic vision enhancement systems. At young ages, children learn to
understand pictures as representations of objects (Brandsborg 1996; Hyvarinen
2000). In children with VI, this learning may be disrupted by the use of eyeglasses
or other lens-based optical aids, which can result in the division of an image into
5 Assistive Technology for Students with Visual Impairments and Blindness 123
segments. Perception of only a segment of an image at a given time poses an
obstacle to learning in that young children typically do not have the cognitive
capability to view segments of an image, recognize their relationships to the whole
image, and infer their representation of the whole image.
Electronic vision enhancement systems (EVES), also known as closed-circuit
televisions (CCTV) can facilitate the viewing of whole images and have been
suggested as supports for children’s learning related to picture representations
(Hyvarinen 2000). EVES involve video cameras and real-time display of images
on screens (Wolffsohn and Peterson 2003). The devices range in size from large
desktop units to hand-held devices, and transmit images to TVs, computer
monitors, in-built screens, or head-mounted displays. EVES enable variable
magnification (e.g., 2X to 60X) and image manipulation (e.g., reversing image
contrast, altering colors).
Technologies that Engage Senses and Abilities Other than Sight
Development of haptic awareness and later learning of Braille may be supported
by a variety of play items designed to engage children’s sense of touch and
exercise their haptic awareness (Holbrook 2006; Hyvarinen 2000). For example,
research has shown play with textured toys can promote use of the visual cortex for
tactile processing in children with VI (Theoret et al. 2004). Also, engagement with
Braille readiness books, that present textures and raised shapes and symbols, has
been found to improve children’s fine motor skills and tactile sensitivity development
(Roth and Fee 2011).
Assistive Technologies for Reading
The act of reading is central to many learning tasks in contemporary schools
(Atlick 1998; De Castell et al. 1986; Friend 2011). In addition to granting access to
educational materials, literacy is a requisite skill for a wide range of work-related,
leisure, and life maintenance activities in modernized societies (e.g., Graff 1978;
Norris and Phillips 2003). Fittingly, provision and instruction in use of alternative
reading materials typically comprise the primary efforts of teachers of students
with VI and blindness (Friend 2011; Galvin and Scherer 2004). Below, we
describe various technologies that support reading, learning and performance in
students with VI and blindness, and when possible, we summarize research on
their use.
124 A. M. Mulloy et al.
Technologies that Enhance Sight Capabilities
Large print text. Individuals with low vision may have difficulty viewing small
print and making the optical movements required for reading text (American
Foundation for the Blind [AFB] 2013f). One possible solution for increasing the
readability of text is to use large print (AFB 2013b, f). Large print documents
typically make use of font sizes 18 or greater (AFB 2013b; Kitchel 2013). While
font size is an important component of large print documents, other factors such as
the size of margins and spaces among lines of text, font type, color contrast,
number of characters per line, and the distance between the reader and text
materials can influence readability and should be manipulated according to the
reader’s abilities (AFB, 2013f; Kitchel 2013; Lueck et al. 2003). A variety of large
print documents such as books, calendars, address books, and labels are commercially
available through websites, such as Abledata.com, and print houses,
such as American Printing House for the Blind and American Foundation for the
Blind. Word processors can also be used to create large print documents for
on-screen viewing or for printing (Evans and Blenkhorn 2004).
Research on the efficacy of large print documents has generally demonstrated
positive correlations between improvements in reading rates (e.g., words read per
minute) and increases in print size for individuals with low vision (Bangor 1998;
Lueck et al. 2003; Lovie-Kitchin et al. 2001). Further, visual acuity and age appear
to moderate the effects of large print on reading rates (Lovie-Kitchin et al. 2001).
For example, Lueck et al. (2003) found the reading rates of fourth graders with low
vision tended to decrease with decreases in text size and increase with increases in
font size until the diagonal dimensions of letters were about two to four times
greater than the individuals’ minimum threshold for identification. The researchers
hypothesized that the increases in eye and head movements required to read larger
fonts prevented further increases in rate. Additionally, participants with relatively
better visual acuity had greater increases in rate as text size increased than those
with poorer acuity. In another study with students with low vision, ages 7 to 18, the
majority of children achieved near normal reading rates with large print sizes
(Lovie-Kitchin et al 2001). The study results indicated age and visual acuity were
associated with the magnitude of individuals gains in reading rates. To further
illustrate, in a study conducted with legally blind students font sizes of text
displayed on a computer screen of 12 to 14 were too small to read. However,
participants successfully read font sizes of 18, 24, and 30 (Bangor 1998).
While research supports relationships between print size and reading abilities
for individuals with VI, studies that compared vision aid use with standard print to
large print use alone obtained mixed findings. In a study conducted with legally
blind and partially sighted students, test scores on a large print form of a reading
test were not substantially higher than scores on a test in font size 10 when optical
aids (e.g., magnifiers, glasses) and non-optical aids (e.g., reading lamps and
reading stands) were used (Sykes 1971). Measures of reading comprehension and
reading rate were not significantly different across conditions, and use of large
5 Assistive Technology for Students with Visual Impairments and Blindness 125
print was not associated with decreases in reading distances. The partially sighted
participants did, however, report less visual fatigue after reading the large print. In
contrast, Farmer and Morse (2007) found magnifiers conferred greater benefit than
large print documents. Oral reading tests were conducted at the beginning and end
of a school year with students with low vision. In reading instruction during the
school year, the students received either large print materials or typical sized print
materials and magnifiers. Improvements in reading rates were similar between
groups. However, while no students in the large print group made substantial gains
in reading comprehension, five of the eight students in the magnifier group did.
Additionally, case studies conducted by Koenig et al. (1992) involving children
with low vision documented that students’ reading rates of regular print with
optical aids were comparable or superior to reading rates of large print alone. In
these case studies, participants reported more positive appraisals of optical aids
than large print. The findings of these comparative studies have been corroborated
by teacher reports that students who used optical devices achieved higher reading
levels than students who used large print materials (Corn 1990).
Researchers concerned with the lack of consistent benefits from use of large
print have examined how elements of print appearance in large print documents
may affect reading abilities. In the previously discussed study, which evaluated the
impact of text size on a computer screens, reading response times and error rates
were found to covary with changes in the print’s contrast and polarity (Bangor
1998). In another study, increased letter spacing was associated with improved
reading speed and decreased minimum font size required by most participants with
low vision (McLeish 2007). Also, in research with typically developing children,
increased letter spacing led to more improvements in word identification and
reading rate than did increased letter size (Hughes and Wilkins 2002).
Despite mixed findings about the benefits of large print text, many individuals
with low vision use large print resources. In a survey of adults with low vision in
Greece, 28 % reported using large print text ‘‘a lot,’’ 9 % used it ‘‘quite a lot,’’
while 55 % reported that they never used large print materials (Goudiras et al.
2009). Access to large print documents likely plays a role in the utilization of these
resources in schools. In the United States, availability of large print textbooks in
schools differs from state to state and district to district (Emerson et al. 2006).
Issues such as funding and overall state resources for people with VI and blindness
affect availability. For example, some states receive greater quantities of volunteered
APH resources and some districts allot more money for textbook purchases.
Also, due to production issues (e.g., lack of personnel, insufficient use of technology)
large print texts are frequently delivered in an untimely manner and/or
may not be available in an individual’s needed font size.
Typoscopes. Typoscopes, also called writing guides, are non-optical devices
typically made of dark cardboard, plastic, or metal, with cutout spaces that are
overlaid lines of writing (AFB 2013h). Although some are specifically designed
for writing, the guides are often used to assist students with low vision in reading
(Lueck and Heinze 2004). Typoscopes may reduce glare and support readers’
126 A. M. Mulloy et al.
scanning across a page and shifting to the beginning of a new line. Typcoscopes
may also reduce the minimum print size individuals need to discriminate between
letters (Collins 2000).
Although there is limited research on the effectiveness of typoscopes for
improving reading, some data suggest they can be helpful. In one study, low vision
rehabilitation patients who reported seeing text as ‘‘jumbled’’ or ‘‘muddled’’ were
given typoscopes with adjustable windows. Sixty percent of patients initially
reported that typoscopes were helpful. Follow up after a year revealed 30 % of
patients still used typoscopes on a regular basis and 50 % no longer experienced
text as ‘‘jumbled’’ when not using a typoscope (Collins 2000). In another study,
students with low vision underwent treatment that included use of reading stands,
typoscopes, direct illumination, and/or large print materials (Shaaban et al. 2009).
While data were not disaggregated by the type of low vision aids prescribed, the
overall improvement in distance and near visual acuity task performance was
statistically significant and 76 % of patients reported being satisfied with their low
vision aids.
Reading stands. Book or reading stands are display supports that may reduce
the physical stress or fatigue experienced by readers with VI who are prone to hold
reading materials close or bend over surfaces to view text (Presley and D’Andrea
2009; AFB 2013f). Stands may also be helpful for readers of Braille (Presley and
D’Andrea 2009). Varieties of stands are commercially available in portable,
desktop, and floor models, and can also be fashioned out of common materials
such as a closed, three-ring binder. The selection of an appropriate size and type of
stand should be based on the needs of the individual.
The efficacy research which addresses reading stand use is limited. In the
previously mentioned study by Shaaban et al. (2009), treatment packages for
students with low vision included reading stands. As described above, treatment
resulted in improvements in distance and near visual acuity task performance and
satisfaction with treatment in 76 % of patients. Also, Gothwal and Herse (2000)
analyzed the records of 220 children who received services at a low vision center
in India and found reading stands were used in 6 % of treatments and were found
acceptable by both parents and children.
Lamps. Improving lighting can be an effective way to make reading tasks easier
for individuals with low vision (AFB 2013b; Bowers et al. 2001). Differences in
vision profiles warrant careful selection of lighting to match individuals’ needs
(AFB 2013b). Any of a variety of common reading lamp bulbs, such as highwattage,
natural light (total-spectrum), compact fluorescent (CFLs), incandescent,
and combinations of CFLs and incandescents may be effective reading aids when
focused on reading materials. Research which compares bulbs’ effects on reading
performance in people with low vision has found no one bulb type stands out as
superior (Eperjesi et al. 2007). Effects of a variety of bulbs were found to be
statistically similar when results are aggregated across individuals. A large number
of commercially available lamps have been designed for individuals with low
vision to use for a variety of tasks, including reading (Gerritsen 2001). Popular
lamps include variations of the OttLite, a total-spectrum lamp which has bright
5 Assistive Technology for Students with Visual Impairments and Blindness 127
natural-appearing light, the Reizen Low Vision Floor Lamp, which uses an
incandescent bulb that produces minimal glare and a warm hue, and the FD-100
halogen table lamp, which produces strong brightness.
Research suggests lighting enhancements can improve students’ reading performance.
For example, in a study of individuals with low vision, participants’
visual acuity, minimum-required print size, and reading rate all improved at levels
of illumination higher than participants’ identified illumination preference at the
study outset (Bowers et al. 2001). The authors of the study recommended that
individual assessments for optimal lighting should consider objective measures of
reading ability in addition to subjective ratings of visual comfort and lighting
preference.
Despite the potential benefits, many people with VI do not strategically use
lighting to improve their reading. In a study of typical reading environments of
individuals with VI, 10 % of the reading places used by participants were found
to have very high, adequate illumination and 63 % were found to have low,
inadequate illumination (Lindner et al. 2001). Single, ceiling light sources were
predominant in 60 % of reading locations and additional lights were only present
in 40 % of locations.
Lens-based magnification aids. Lens-based magnifiers, such as telescopes and
hand-held magnifiers, are task-specific optical aids that enlarge images and allow
greater perception in users (Cline et al. 1997; Bowers et al. 2001). In contrast to
regular glasses, which are often designed to maximize vision across a variety of
contexts and activities, these magnifiers are prescribed for specific activities based
on the user’s context-related needs. Generally, lens-based magnification aids can
be grouped into two categories: near-viewing optical aids and distant-viewing
optical aids.
Near-viewing optical aids are used in tasks performed within arm’s length, such
as reading, writing, drawing, and sewing. Near-view optical aids include stand
magnifiers, hand-held magnifiers, and magnifying reading glasses. Each of these
aids involves a separate set of utilities and limitations. For example, hand-held and
stand magnifiers may be commonly used by students with a variety of visual
acuities and visual fields, while each pair of magnifying reading glasses are only
useful to students with a particular visual acuity and visual field combination.
Stand magnifiers are particularly useful for students with poor motor control due to
their fixed position, however, for the same reason, they may be inappropriate for
viewing some objects, such as large books. Hand-held magnifiers offer great
flexibility in terms of holding distance and location, but the requirement of holding
a steady position for reading can lead to fatigue in hands, arms, and/or shoulder
muscles.
Distant-viewing optical aids are used in tasks performed at distances greater
than arm’s length, such as reading a chalkboard, viewing another’s skill demonstration,
and watching a sporting event. Common distant-viewing optical aids
include hand-held and spectacle-mounted telescopes. Similar to above, these aids
involve separate utilities and limitations. Hand-held telescopes are highly portable
and typically the least expensive. These devices are best for ‘‘spot’’ viewing, such
128 A. M. Mulloy et al.
as reading clocks and bus numbers. However, hand-held telescopes require
moderate or better motor control and users must remain stationary. Spectaclemounted
telescopes do not require users to remain stationary and circumvent the
need for hand coordination and stability. Although, these aids are typically
permanently attached to eye glasses and are regarded as unaesthetic.
Research on use of lens-based magnification aids indicates they can improve
students’ reading rate and comprehension, and facilitate advancements in reading
fluency (e.g., Corn 1990; Farmer and Morse 2007; Koenig et al. 1992). However,
outcomes have been found to vary across individuals (e.g., Rosenthal and
Williams 2000), which suggests identification of the device that will enable the
highest levels of reading performance in a student requires trial runs, evaluations,
and comparisons with each student.
Electronic magnification aids. As discussed above with regard to AT for preacademic
learning, electronic magnifiers are commonly termed electronic vision
enhancement systems (EVES) and closed-circuit televisions (CCTV; Wolffsohn
and Peterson 2003). Compared to lens-based magnification aids for reading, EVES
may support more natural working distances, better posture, and longer durations
and higher rates of reading, as well as protect against light loss (Harper et al. 1999;
Mehr et al. 1973; Uslan Shen et al. 1996). However, comparative research has
produced conflicting findings. Some work suggests use of lens-based magnification
aids is associated with the highest reading outcomes (e.g., Goodrich et al. 1980;
Harper et al. 1999), while other studies have found EVES to provide superior
support (e.g., Goodrich and Kirby 2001; Stelmack et al. 1991; Watson et al. 1997).
Further, research which compares various EVES devices has found outcomes to
vary across individuals and devices (e.g., Lusk 2012; Ortiz et al. 1999; Peterson
et al. 2003). Taken together, these findings underline the need to conduct evaluations
with each individual student during trial runs with a variety of magnification
aids before selecting a device.
Technologies that Engage Senses and Abilities Other than Sight
Braille reading materials. Learning to read Braille characters with fingers is a
route to literacy that circumvents the limitations of VI and blindness. Braille codes
have been created for many languages worldwide using the standard rectangular
cell, which contains up to six dots in a 2 by 3 grid (Spungin 1990). Reading
materials are typically available in 3 levels of encoding: Grade 1, in which words
are fully spelled, Grade 2, which uses abbreviations and contractions, and Grade 3,
which involves authors’ personal and nonstandard shorthand. The IDEA legislation
mandates provision of instruction in and use of Braille with students with VI
and blindness unless assessment data suggests an alternative reading media is more
appropriate for the student (IDEA 2004a).
5 Assistive Technology for Students with Visual Impairments and Blindness 129
Research on the instruction and reading of Braille has documented many
positive outcomes, including higher educational achievement and self-esteem, and
greater financial self-sufficiency (e.g., Ryles 1997; Schroeder 1996; Stephens
1989). Experts in Braille instruction have argued students in Braille literacy
programs should receive between 1.5 and 2 h of literacy instruction per day, as this
is the typical amount of time sighted students receive literacy instruction in
primary grades (Rex et al. 1994; Koenig and Holbrook 2000). Evidence supports
daily Braille literacy instruction. Ryles (1997) found students with legal blindness
who received Braille literacy instruction four or five times per week attained
significantly and substantially better literacy skills than comparable students who
received infrequent instruction.
Braille translation software and computer printers. To convert typical reading
or instructional materials to Braille, students with VI and blindness or their
teachers can use Braille translation software and computer printers (Disabilities,
Opportunities, Internetworking, and Technology Center [DOIT] 2013b; Taylor
2001). Braille translation software recognizes a variety of digital text file formats
(e.g., MS Word, PDF, HTML, RTF) as well as allow manual entry of text. The
programs convert text to Braille characters in the user-specified language code
(e.g., Spanish, English) and encoding grade (i.e., 1 or 2). Common translation
software includes Duxbury Braille Translator by Duxbury Systems and Braille
2000 by Computer Application Specialties. Such programs submit Braille character
files to special Braille printers, known as embossers. These printers produce
raised dot Braille characters on thick paper. Braille embossers vary greatly in price
and features. For example, some embossers are capable of producing Braille on
both sides of paper (i.e., interpoint Braille), while others print on single sides only.
The speed of embossers can range from production of 10 characters to 800
characters per second. High-end embossers can cost over $80,000, while basic
versions range between $1,500 and $2,000.
Refreshable braille display. Refreshable Braille displays enable tactual reading
of text from computer screens (AFB 2013c). The devices receive output from
screen readers (described far below) and produce lines of Braille characters with
small pins that raise and lower as the user navigates a screen and encounters text.
Refreshable Braille displays can be expensive, however, prices vary greatly based
on device features (Braille Note Users 2012). Units differ in the number of
refreshable characters (i.e., 20 to 80 Braille cells), note taking and file storage
capabilities, compatibility with specific screen readers, input button arrangements,
and screen navigational tools. Additionally, some devices only facilitate reading
(e.g., PacMate by Freedom Scientific, Focus by Freedom Scientific, Alva by
VisonCue), while others enable both reading and Braille input (i.e., note taking;
e.g., BrailleNote by HumanWare, Braille Sense by HIMS, and PacMate Omni by
Freedom Scientific).
Research on refreshable Braille displays suggests the devices have limitations
related to text accessibility and efficiency of use (Kamei-Hannan 2008; Sodnik
et al. 2012). Kamei-Hannan (2008) evaluated the accessibility of computer-based
language and reading tests. Students who were able to independently operate the
130 A. M. Mulloy et al.
devices and associated screen readers (i.e., with speech output disabled) discovered
13 % of the language test questions could not be read due to punctuation (e.g.,
underlining) that was not translated to Braille. Additionally, the students were
unable to comprehend 21 % of the reading test questions due to difficulties related
to scrolling through long passages of text. Sodnik et al. (2012) compared use of a
refreshable Braille display and screen reader with a novel auditory interface
which produced spatially positioned synthetic speech. In observations of a series of
reading and information recording tasks, the researchers found the average task
completion time was substantially less when participants used the spatial auditory
system (i.e., 3 min, 12 s) than when they used the refreshable braille display and
screen reader (i.e., 8 min, 38 s). However, no significant differences were found
regarding the accuracy of information recorded.
Some research has investigated the use and availability of refreshable screen
displays. For example, in a survey of college disability support service coordinators,
respondents reported refreshable braille displays were available on only
13.9 % of campuses (Michaels et al. 2002). In another survey of teachers of
students with visually impairments and blindness, teachers reported that only 2 %
of students used refreshable Braille displays (Abner and Lahm 2002). Authors
have hypothesized that the high cost of the devices and the decreasing number of
individuals who read Braille has limited the popularity of refreshable Braille
displays (Chiang et al. 2005).
Audio format materials. Audio format reading materials enable easy access to
content for students with VI and blindness. In recent years, the availability and
accessibility of audio books and other reading materials has greatly increased
(Majerus 2011). Students with VI and blindness have a variety of options for
engaging with audio format reading materials. They may use (a) dedicated audio
book players (e.g., Booksense by HIMS), (b) devices that display text and play
audio (e.g., Victor Reader Stream by Humanware), (c) multipurpose audio devices
(e.g., iPod by Apple), and (d) computer software (e.g., Easy Reader by Dolphin).
Research on audio format materials is limited to a single study. In interviews
with students with VI and blindness, Adetoro (2012) found audio format materials
were preferred over Braille reading materials by over half of the students due to
ease of understanding and playback, and their teachers’ ineptitude with Braille.
Screen and document reading software. When students’ visual impairments
are severe to the degree that they cannot read or cannot efficiently read printed
materials or type on computer screens, screen and document reading software may
be employed to support access to reading content (AFB 2013e). These softwares
allow students to convert text on screens and in documents to synthetic speech
(i.e., audio output). To do so, students use a variety of key strokes to undertake
actions, such as move about text, read a sentence or paragraph, spell out a word,
and identify the location of the cursor. Additionally, the programs allow students
to control computer operating systems and applications. In place of the typical
visual feedback regarding computer input (e.g., clicking an icon with a mouse
cursor opens an on-screen application window), screen and document reading
software provides audio feedback (e.g., verbal announcement that an application
5 Assistive Technology for Students with Visual Impairments and Blindness 131
has opened). Most versions of screen and document reading software allow users
to vary several qualities of the synthetic speech, including rate and pitch, as well as
to choose from among a variety of language and region-specific accents (e.g.,
English with a British accent). Common screen and document reading software
includes both operating system-based programs (e.g., Narrator for Microsoft
Windows Operating Systems, Voiceover for Macintosh Operating Systems) and
third-party applications (e.g., JAWS from Freedom Scientific, Kurzweil 3000 by
Kurzweil Educational Systems). As mentioned above, some softwares are capable
of transferring information to refreshable Braille displays. Additionally, screen and
document reading software can grant students with VI and blindness access to
printed materials following their scanning and processing with optical character
recognition software (e.g., ABBYY FineReader by ABBYY).
Research suggests students with VI and blindness require extensive training and
on-going support to independently use screen and document reading software (Earl
and Leventhal 1999; Lazar et al. 2007; Leventhal and Earl 1997). For example,
students must learn many key strokes for initiating software functions and maintain
current knowledge of procedures for accessing new file types, new versions of
document applications, and re-organized webpages. Students may also benefit
from typing instruction and keyboards adapted for persons with VI and blindness.
In survey research with users of screen and document readers with VI and
blindness, Earl and Leventhal (1997, 1999) found that a majority of respondents
had some form of difficulty with reading tasks attempted in Microsoft applications.
They further found 40 % of their sample avoided particular tasks altogether due to
the difficulties. Similarly, Lazar et al. (2007) found users of screen and document
readers had high levels of frustration in response to confusing speech outputs,
software crashes, and incompatibility between the software and various reading
documents (e.g., PDF variations).
Assistive Technologies for Writing
Visual impairments and blindness potentiate a number of challenges to students in
writing tasks involving typical, visual mediums, such as ink on paper or type on
computer screens (AFB 2013d, h; Ponchillia and Ponchillia 1996). In these visual
mediums, students with VI and blindness can experience difficulties in learning the
mechanics of writing (e.g., punctuation, spelling), taking notes during classes, and
engaging in the various phases of composing (e.g., prewriting, drafting, editing)
due to limitations of their visual acuity, visual field, and functional use of vision.
Below, we describe the variety of AT used to support students with VI and
blindness in writing tasks. When possible, we also summarize research on use of
the AT.
132 A. M. Mulloy et al.
Technologies that Enhance Sight Capabilities
Paper and writing utensils that provide visual and tactile cues. Individuals with
VI may have difficulty with a variety of skills required for writing by hand, such as
spacing and placing letters, and following lines (Ponchillia and Ponchillia 1996).
Specialized paper and writing utensils that provide sharp contrasts, thick markings,
and tactile feedback may aid students’ recognition of appropriate locations for
writing, increase handwriting legibility (AFB 2013h; Ponchillia and Ponchillia
1996). Paper widely known as ‘‘bold-lined paper’’ has dark, wide lines that may
improve recognition of intended writing locations via increased contrast and visual
cues. Bold-lined paper, notebooks, and graph paper are available in a variety of
colors and line spacing (Russotti et al. 2004). Thick, felt-tip markers (e.g., 20/20
by MaxiAids) are often used in conjunction with bold-lined paper (AFB 2013d).
The markers similarly provide high levels of contrast and visual cues, and may
support students’ formation, placing, and spacing of characters. Individuals who
need tactile support for writing by hand may benefit from ‘‘raised-line paper’’ and
writing utensils that provide high levels of tactile feedback on writing execution
(e.g., HighMark by MaxiAids, Thermalpens by Repro-Tronics; thick, lead, or
graphite pencils).
Research on paper and writing utensils that provide visual and tactile cues is
limited to one supportive study. A group of Indian researchers who investigated
custom intervention packages for students with VI found 80 % of participants who
received bold-lined paper and felt-tipped markers considered these particular
supports were helpful (Khan et al. 2003).
Typoscopes. As described in the above section on AT for reading, typoscopes
are devices typically made of dark cardboard, plastic, or metal, with cutout spaces
that are overlaid writing spaces (AFB 2013h; Ponchillia and Ponchillia 1996).
Typoscopes may help guide letter formation, spacing, and placement via provision
of physical boundaries and contrast. The writing guides may be rigid in construction
or flexible, allowing for formation of letters that descend below the
interior edge of the typoscope when aligned with the writing line (e.g., ‘‘g’’ or
‘‘p’’). Some authors suggest flexible typoscopes require greater skill with writing
utensils for successful use (AFB 2013d). A variety of typoscopes are commercially
available, including writing guides specifically designed for writing checks, letters,
and signatures. Additionally, typoscopes may be made out of common materials,
such as cardboard.
Technologies that Engage Senses and Abilities Other than Sight
Braille making devices. Students with VI and blindness can make Braille documents
with a slate and stylus, Braille typewriters (i.e., Perkins Braillers), or
computer systems including Braille embossers, screen and document readers, word
processors, and/or Braille translation software (Caton 1991). Braille slates consist
5 Assistive Technology for Students with Visual Impairments and Blindness 133
of two pieces of metal or plastic attached with a hinge. The front piece contains
rows and columns of holes, grouped in Braille cell rectangles (i.e., 2 by 3 hole
grids). The back piece contains rows and columns of slight depressions which
align with the holes on the front piece when the hinge is closed. Users insert a
piece of thick paper between the slate pieces, close the hinge, and then, starting
from the right side and moving left, press the stylus (i.e., a blunted bradawl) into
the slate’s holes to create the raised dots of Braille characters. When finished, users
remove the paper from the slate and turn it over to read the Braille characters
pushed up from the back side of the paper. Perkins Braillers are manual typewriters
that contain six keys, corresponding to the six dots in Braille code, as well
as space, line space, and backspace keys. While Braillers are more efficient means
of producing Braille characters than use of a slate and stylus, review of what one
has written is less convenient. The consensus among teachers of students with VI
and blindness is that instruction in Braille literacy should include training with the
slate and stylus, beginning in grade 3 or 4, and instruction in use of typewriters,
beginning in grades 1, 2, or 3 (Koenig and Holbrook 2000).
Voice recorders. In school settings where accuracy and speed of note taking or
writing is important, students with VI and blindness may benefit from making
audio voice recordings (e.g., using digital, tape, or other electronic devices; Attmore
1990). Digital voice recorders may also be useful for organizational purposes,
such as recording assignments or appointments. A variety of commercially
available devices combine voice recording features with word processors (e.g.,
AudioNote by Luminant Software), word prediction (e.g., Premier Predictor Pro
by Premier Assistive Technology), and talking dictionaries (e.g., KeyAccess by
Premier Assistive Technology). School districts commonly provide voice
recording devices to students with VI and blindness as accommodations for
classwork and tests (e.g., Beech 2010).
Speech-to-text software. As an alternative to use of writing utensils and
keyboards, students with VI and blindness may prefer to use speech recognition/
dictation software that translates speech to text (AFB 2013g). Common speechto-text
programs include Dragon NaturallySpeaking by Next Generation
Technologies, MacSpeech Scribe by Nuance, and PlainTalk by Apple (Stefanik
2012). In addition to speech-to-text translation, these programs permit use of voice
commands for functions such as opening, editing, and saving computer files. Given
speech-to-text programs were not specifically designed for use with screen readers,
users of both software types occasionally encounter compatibility problems.
Supplemental software, such as J-Say by Next Generation Technologies, can
resolve such problems (AbilityNet 2007).
The limited literature on speech-to-text software involves mixed depictions of its
utility. Survey research conducted with college-level disability support specialists
suggests students with VI and blindness widely and successfully use speech-to-text
programs (Michaels et al. 2002). Seventy-three percent of respondents reported
they provided the software to students and rated it as moderately to highly useful.
However, in a study of use of speech-to-text software by novice, sighted users,
researchers found participants had difficulty correcting translation errors and
134 A. M. Mulloy et al.
required greater lengths of time for composition compared to when they used
keyboards (Karat et al. 1999). These results seem to indicate the development of
proficiency with speech-to-text software requires training and practice. Further,
Schneiderman (2000) suggested composition with the software involves greater
cognitive demands than keyboard use and, thus, may not be appropriate for certain
students due to age or disability status.
Text-to-speech software. Talking word processors may support spelling and
composition in students with VI and blindness (e.g., Write: Outloud by Don Johnston,
Intellitalk by IntelliTools, Read and Write Gold by TextHelp; Angelocci and
Connors 2002; Erickson 2004; Nicohls 2013). Students may derive similar support
from combined use of typical word processors and screen and document reading
software (e.g., JAWS by Freedom Scientific, Kurzweil 3000 by Kurzweil Educational
Systems). The talking word processors and screen and document reading
software provide auditory review of words as they are typed and allow listening to
previously typed text, thus enabling students’ recognition of spelling errors (i.e., via
the resulting incorrect pronunciation of words) and needs for revisions in compositions.
Students with low vision may additionally benefit from the programs’
flexibility regarding text size and color, background color, and word highlighting
during typing and auditory review. Authors have identified compatibility problems
between talking word processors and screen readers related to keystrokes, spelling
alerts, and automatic spell checks (Angelocci and Connors 2002).
Spelling and grammar checking software. Students with VI and blindness may
obtain support for spelling and grammar from a variety of software programs.
Typical word processors, such as MS Word by Microsoft, may be configured to
work in conjunction with the JAWS screen reader to detect spelling and grammar
errors (Microsoft 2013). Several previously mentioned programs (e.g., Read and
Write Gold, Kurzweil 3000, KeyAccess) offer audio output spelling and grammar
checking features (Angelocci and Connors 2002). Also, talking dictionaries
designed for students with VI and blindness are available as hand-held devices
(e.g., Franklin Speaking Language Master Special Edition by Franklin Electronic
Publishers) and screen reader-compatible software (e.g., English Talking Dictionary
by Premier Assistive Technology).
Survey research with authors with blindness suggests students with VI and
blindness stand to benefit from spelling and grammar support (Evans et al. 2003).
Respondents in the study reported regular use of spelling and grammar checking
software, and indicated needs for such support.
Assistive Technologies for Mathematics
Given that much of the language of mathematics relies on visual reference,
learning mathematical concepts can be especially challenging for students with VI
and blindness (Jan et al. 1977; Dick and Kubiak 1997). For example, concepts such
as direction, quantity, and shape require substantially more cognitive processing
5 Assistive Technology for Students with Visual Impairments and Blindness 135
when visualization is not possible. Textual and audio supports, such as Braille
textbooks and talking calculators, can be useful in facilitating student’s access to
mathematics materials (Dick and Kubiak 1997), however, tactile support and
haptic technology at times offer advantages in the promotion of concrete mathematical
understandings in students with VI and blindness (Bussell 2003; Karshmer
and Bledsoe 2002). We describe technologies in each of these areas below, and, to
the extent possible, research that supports their use.
Technologies that Enhance Sight Capabilities
Interactive whiteboards. Promethean boards and SMART Boards are large-format,
interactive whiteboards that display a computer image and allow users to
write directly on the screen. There is some evidence that these devices provide
specific advantages for students with VI, such as providing users access to the
projected image on a screen replicated at their desk (Bosetti et al. 2011), or
enlarging text, tables, and graphics that otherwise might not be visible (Scholastic
2013; Smarttech 2005). Moreover, students with light sensitivity are often able to
interact with the SMART Board at close distances (Scholastic 2013). Drawing on
student and teacher expertise, a recent Illinois State University project offered
guidance for using interactive whiteboards with students with VI, such as allowing
students to access information displayed on whiteboard screens via devices such as
iPads and using the SMART Board to teach students to locate coordinates on a
graph (Illinois State University 2012).
Adapted graph paper. As in other subject areas, access to mathematics texts
and assessments can be enhanced through large print and graphics (Landau et al.
2003; Willingham et al. 1988). With respect to graphing in particular, given the
small-sized boxes and light-colored lines often used for traditional graph paper,
graphical items are often inaccessible to students with VI (Royal National Institute
of the Blind [RNIB] 2011). Large, bold-lined, or high contrast graph paper may be
useful in this regard, and magnifying glasses can be used to supplement mathematics
texts (Dick and Kubiak 1997; Landau et al. 2003). This specialized graph
paper can be used in combination with pushpins and corkboards, flexible wax
strips or felt-tip markers that help to create graphical points, lines, curves, and
figures (Dick and Kubiak 1997). In addition, tactile graph paper is available for
students with blindness (RNIB 2011).
Technologies that Engage Senses and Abilities Other than Sight
Adapted calculators. A variety of standard and scientific calculators are available
that offer modifications for students with VI and blindness, such as large keys, high
contrast screens, and Braille input and output (Center for Assistive Technology
136 A. M. Mulloy et al.
and Environmental Access [CATEA] 2009). Many accessible calculators also
provide auditory output. These talking calculators have been shown to increase
computational accuracy and improve efficiency in solving mathematics problems
for students with VI (Champion 1976/1977). A recent study of a voice input,
speech output (VISO) calculator for use with high school students with VI demonstrated
that the tool increased efficiency and fostered greater independence for
completing computational problems (Bouck et al. 2011).
In addition to supporting math computational skills, scientific and graphing
calculators that include Braille or tactile keyboards and offer auditory output or
haptic (i.e., vibratory) feedback may facilitate the learning of more advanced
mathematics concepts (CATEA 2009). Examples of calculators or programs that
offer auditory support for graphing procedures include the Accessible Graphing
Calculator (AGC) and the Sonification Sandbox (Osterhaus 2002; Walker and
Lowey 2004). More recent software developments also provide tactile support for
graphing and allow students with VI and blindness to convert mathematical data
and graphs to tactile forms using a Braille or graphics embosser that connects to
the calculator (e.g., the Orion TI-84 Plus; Orbit Research 2013). However, there is
little, if any, empirical support for the use of these calculators (Bouck et al. 2011),
and systematic study of how to create effective auditory graphics in particular is
limited (Walker and Nees 2005). Additionally, both computational and scientific
calculators for students with VI have significant limitations with respect to size,
price, and availability (Bouck et al. 2011).
Abacus. The abacus is an inexpensive, mechanical tool which may help students
with VI and blindness understand mathematical relationships in a non-visual
format (Ferrell 2006). Although an abacus can facilitate the learning of foundational-level
mathematics, such as addition, subtraction, multiplication, and division,
as well as higher-level mathematics, including fractions and decimals, there
is conflicting evidence related to its effectiveness with students with VI and
blindness. For example, one study showed that an abacus training program
improved the computational skills of students with blindness (Nolan and Morris
1964), while another demonstrated that mental calculation and Braille computation
were more efficient and accurate than using an abacus (Kapperman 1974).
Math manipulatives. When presenting visual concepts to students with VI
and blindness, hands-on experiences with manipulatives can support learning
(Belcastro 1993; Dick and Kubiak 1997; La Voy 2009; Osterhaus 2011). Specialized
manipulatives designed to meet the needs of students with vision-related
disabilities, as well as manipulatives used in mathematics instruction of students
without disabilities, may facilitate students’ learning of math concepts such as
number sense, addition, graphing, and geometry. In fact, the use of concrete
mathematical aids is one of just a few evidence-based practices that can increase
computation accuracy (Ferrell 2006). Specialized manipulatives may utilize Braille,
the Nemeth mathematics code, raised tactile elements (e.g., shapes and textures) or
three-dimensional geometric components (Van Scoy et al. 2005). Examples include
Tack-Tiles, number blocks, number lines, rulers, dice, counting rods, and algebra
tiles (e.g., Belcastro 1993; Bussell 2003; Karshmer and Farsi 2008).
5 Assistive Technology for Students with Visual Impairments and Blindness 137
Although a variety of mathematics manipulatives are available for students with
VI and blindness, empirical evidence supporting their effectiveness is relatively
limited. One small study with first-grade students with blindness demonstrated
large effects of using specialized rods for teaching addition and subtraction
(Belcastro 1993). The rods were marked with grooves and dimples representing
different numbers. Another study, which documented similarly large effects,
showed students with VI benefited from the use of a variety of tactile and highcolor
contrast manipulatives (La Voy 2009). Additionally, two studies focused on
college-age students showed use of paper shapes for surfaces and slices of geometrical
figures promoted understanding of two- and three-dimensional figures
(Spindler 2006), and that cardboard and modeling clay facilitated the teaching of
statistical concepts (Gibson and Darron 1999). It is important to note, however,
that the integration of audio and haptic support when using manipulatives may
better support the learning of math concepts than the use of manipulatives alone
(Crossan and Brewster 2008). Despite their potential, mathematics manipulatives
are not always provided to or readily available for teachers who work with students
with VI and blindness (La Voy 2009).
Tactile graphics. Presentation of information with tactile graphics represents an
alternative to visual illustration that draws on haptic perception (Gardner 1996).
Several specialized technologies, as well as common crafts materials, can be used
to create tactile graphics (DOIT 2013a; Jayant 2006). Specialized technologies
include Braille embossers (e.g., The Phoenix embosser by Enabling Technologies),
dedicated tactile graphics printers (e.g., the Tiger series by ViewPlus, the
Tactile Image Enhancer by Repro-Tronics), tactile displays, and capsule or swell
paper and heating devices. Braille embossers allow supplementation of tactile
graphics with Braille text, however they are unable to produce high resolution
graphics due to their exclusive production of raised dots. Dedicated tactile
graphics printers can produce high resolution graphics, although they have limited
capabilities to print Braille text. Tactile displays (e.g., the Dot View 2 by KGS)
work with software programs (e.g., ChattyInfty by InftyReader Group) to create
graphics with a matrix of pins that rise and fall to form shapes and Braille characters.
While tactile displays offer the advantages of image scrolling, magnification,
reduction, and real-time display, the devices are very expensive. Capsule and
swell paper offer the advantage of compatibility with typical computer printers.
After printing, the paper is passed through a heating device (e.g., Swell-Form
Graphics Machine by American Thermoform Corporation, Picture in a Flash
Tactile Graphic Maker by HumanWare) which causes the inked portions to swell
and create a raised graphic. Prior to employing these printing methods, a variety of
computer software programs can be used to design graphics. Programs that utilize
scalable vector graphics, such as Corel Draw, Adobe Illustrator, and Microsoft
Word and Powerpoint, are regarded as best for creating tactile graphics due to
features which enable customization of line thickness (Van Geem 2012). If these
specialized technologies are unavailable or inaccessible, common craft materials,
138 A. M. Mulloy et al.
such as glue guns, yarn, and aluminum foil can be fashioned into tactile graphics
(Ryles and Bell 2009; Smith and Smothers 2012). Additionally, tactile graphic
materials are commercially available in academic resource kits for students with
VI and blindness.
Research on tactile graphics supports their use with students with VI and
blindness. Evidence suggests students can interpret complex tactile graphics
(Campbell 1997) and oral explanations improve their understandings of the
illustrated concepts (Krufka and Barner 2006; Schoch 2011). In a comparison of
raised line graphics and relief-based graphics, Krufka and Barner (2006) found that
raised line graphics are associated with greater concept comprehension than reliefbased
graphics. In a study of student attitudes toward mathematics, researchers
found use of tactile graphics can improve students’ appraisals of mathematics
courses (Rule et al. 2011). Despite the potential benefits, tactile graphics are
frequently not employed. Survey research has found that under half of all teachers
of students with VI use tactile graphics with their students (Rosenblum and Amato
2004). The infrequent use may be due to a lack of preparation among teachers to
employ tactile graphics in instruction. For example, in a recent survey, 65 % of
teachers of students with VI reported they needed more training in creating and
teaching with tactile graphics (Rosenblum and Herzberg 2011).
Braille translation software for mathematics. Various computer hardware and
software offer support for Braille users’ study of mathematics (Cooper 2007;
Jayant 2006). Braille representation of numbers and mathematical notations typically
involves the Nemeth code. To produce mathematics documents in Nemeth
code Braille characters or convert Braille documents for sighted readers, teachers
of students with VI and blindness may wish to use translation software for
mathematics. Relevant computer hardware and software involve a variety of different
processes. Numbers and mathematical notations may be converted from
sighted math codes in digital format (e.g., written in MS Word by Microsoft or
Scientific Notebook by MacKichan Software) to Nemeth code Braille characters
(e.g., with Duxbury Braille Translation or Megadots by Duxbury Systems) and
then printed with Braille embossers. For users without sight, creation of sighted
math codes and translation to Braille may be aided by screen readers and voice
recognition software. Some embossers contain translation software and, thus,
remove the need for intermediate translation. For example, the Tiger embosser by
ViewPlus can produce Braille documents from files coded in MathType, the
mathematics code used in MS Word. Also, OCR programs specifically designed to
recognize mathematical expressions, such as InftyReader by InftyReader Group,
can be used with translation software to convert scanned documents into Braille
code for printing. Finally, users fluent in Braille and the Nemeth code may
manually enter characters in Braille note-takers or Braille translation software for
conversion into sighted math codes and printing for sighted readers.
Research related to Braille translation for mathematics has addressed the
manual translation competencies of teachers of students with VI (DeMario 2000;
Rosenblum and Herzberg 2011), the perceived utility of translation hardware and
software (Rosenblum and Amato 2004), and the functionality of OCR systems
5 Assistive Technology for Students with Visual Impairments and Blindness 139
(Jayant 2006). DeMario (2000), Rosenblum and Herzberg (2011) surveyed
teachers of students with VI regarding their self-appraised competencies in manual
translation of Nemeth code. Teachers reported to DeMario (2000) that their
translation competency decreased and their anxiety in response to translation tasks
increased as the complexity of mathematical expressions increased. Rosenblum
and Herzberg (2011) found 84 % of teachers in their sample rated their translations
as excellent or good. However, two-thirds stated they would benefit from further
training in translation for mathematics and 40 % identified themselves as needing
additional training. Together, these findings indirectly support use of translation
hardware and software as an alternative to manual translation. Survey research on
the utility of translation software suggests teachers perceive the systems to have
moderate usefulness, and only minor differences exist between the systems’ utility
(Rosenblum and Amato 2004). In contrast, Jayant (2006) found OCR approaches
differ substantially in their functionality (Jayant 2006). The researcher compared
use of the InftyReader program, a standard OCR system not specifically designed
to recognize mathematical expressions, and use of the two OCR systems in
combination, and found the combined use resulted in 15 % greater accuracy of
translations.
Assistive Technologies for Science
Similar to the study of mathematics, science courses may present challenges to
students with VI and blindness due to the centrality of visually and spatially
depicted information (LiveScience 2013; Senge 1998). A variety of technology
based supports may support science-related learning in students with VI and
blindness. However, very little research has explored their effectiveness in promoting
learning. Below, we describe the available technologies and the research
that supports their use.
Three-dimensional models. A number of three-dimensional models produced
for science courses may be of use in instruction of students with VI and blindness
(National Association of Special Education Teachers 2013). Examples include
models of human bodies and organs for anatomy lessons, molecule construction
kits for chemistry lessons, and models of DNA strands made for biology lessons.
Research investigating use of three-dimensional models of cells found that
students with VI and blindness made significant gains in identification of cell
components (Jones et al. 2006). Further, students reported high levels of interest in
the models as instructional tools.
Tactile graphics. Tactile, graphic illustrations of concepts may support learning
in science course in students with VI and blindness (Independence Science 2013b).
As described above in the mathematics section, various printers, special paper, and
material kits for producing tactile graphics are available commercially, and
common craft materials, such as glue guns, yarn, and aluminum foil are also useful
140 A. M. Mulloy et al.
for creating tactile, graphic illustrations. Several material kits specifically intended
for use in science courses are available from the company Independence Science.
Data collection aids. In recent years, Independence Science has released
versions of a device called Talking LabQuest, which enables independent participation
of students with VI and blindness in a variety of science experiments and
learning experiences in field and laboratory settings (Independence Science 2013a;
LiveScience 2013). The device is a hand-held, portable computer that includes 70
sensors to measure variables, such as pH, temperature, salinity, and motion.
Students operate the device with buttons, the touch screen, or spoken directions.
Via a software add-on, called Sci-Voice Access Software, the device provides realtime
audio announcement of measurement outcomes. The software allows students
to customize the language, pitch, rate, punctuation, and pronunciation of
announcements. Additionally, data are stored for later review and analysis.
Personal computer-based laboratory equipment. After collecting data, students
with VI and blindness can analyze their data with a program called Logger
Pro, by Vernier Software and Technology, which is compatible with screen readers
(Independence Science 2013a; Vernier Software and Technology, 2013). The
software accepts input from the Talking LabQuest, as well as manual entry of data.
Students can use Logger Pro to perform a large variety of analyses (e.g., gas
chromatography analysis, data modeling with specified functions), as well as to
produce custom graphs and tables.
Clinical and Academic Implications for Use of Assistive
Technologies with Students with Visual Impairments
and Blindness
Current research and consensus on practice have a number of implications
regarding AT for students with VI and blindness. Below, we discuss implications
related to assessment, AT selection, teaching and encouraging AT use, technology
abandonment, and future research.
Assessment
Given the variety of assessments pertinent to the abilities and support needs of
students with VI and blindness, due diligence in assessment necessitates collaboration
among professionals from multiple disciplines (Faye 1996; Hyvarinen
2000; Koenig and Holbrook 1995; Topor and Erin 2000). At a minimum,
assessment should involve a medical professional, who can examine the student’s
visual acuity and visual field, and a teacher of students with VI, who can perform a
functional vision assessment and learning media assessment. The involvement of
5 Assistive Technology for Students with Visual Impairments and Blindness 141
professionals from additional disciplines has the potential to increase the utility and
extent of the information produced by assessment (Sadao and Robinson 2010;
Van Hof and Looijestijn 1995). Organizers of assessments should consider
including (a) primary care physicians, (b) pediatric neurologists, (c) opthalmologists,
(d) optometrists, (e) certified low vision specialists, (f) teachers of students
with VI, (g) other special educators, (h) general education teachers, (i) rehabilitation
therapists or counselors, (j) orientation and mobility specialists, and (k) professionals
with expertise in treatment of any comorbid disabilities (e.g.,
occupational therapist).
The value of accurate and valid assessment to subsequent intervention has been
repeatedly established in educational and behavioral research (e.g., Al Otaiba
2011; Iwata et al. 1994) and is widely accepted by educational professionals (e.g.,
IDEA 2004c). As mentioned above, failure to fully identify and address individuals’
needs during the AT assessment and selection process is associated with
dissatisfaction with and abandonment of AT (Cook 1982; Zola 1982). It is thus
safe to assume generation of accurate and valid assessment data facilitates provision
of optimal support to students. The issue of accurate and valid assessment is
most relevant to preschool age students or those with comorbid intellectual
disabilities, multiple disabilities, or autism spectrum disorders (Bergwerk 2011;
Chou et al. 2011; Committee on Practice and Ambulatory Medicine Section on
Ophthalmology, American Association of Certified Orthoptists, American Association
for Pediatric Ophthalmology and Strabismus, and American Academy of
Ophthalmology 2003; Geddie et al. 2013; Hyvarinen 2000; Topor and Erin 2000;
US Preventative Task Force 2011; Utely et al. 1983). For these students, assessment
procedures may need adaptation to yield valid outcomes. Professionals
engaged in assessment should consider the degree of fit between assessment
procedures and the student’s age and abilities other than vision, and contemplate
alternative approaches. Consultation with the student’s parents, teachers, and other
caretakers, as well as other professionals who work with the student can lead to
recognition of inappropriate procedures and suitable alternative approaches
(Bergwerk 2011; Committee on Practice and Ambulatory Medicine Section on
Ophthalmology et al. 2003; Topor and Erin 2000).
Selection of Assistive Technology
In the consideration of AT for a student, the literature suggests best practice comprises
(a) matching AT to students’ goals and needs, (b) involvement of
representatives from multiple disciplines, (c) provision of complimentary supports,
(d) initial and on-going evaluation of AT implementation outcomes, and (e) sensitivity
to students’ cultural norms and preferences. Given the purposes of AT for
students with VI and blindness are to increase or improve their functional capabilities,
support their education and development, and facilitate their independence
142 A. M. Mulloy et al.
(Desch 2013; IDEA 2004c; Sadao and Robinson 2010), AT selected for a student
should match their needs for support in functional tasks and enable attainment of
goals for education and development (Bryant and Bryant 2003; Cook and Hussey
2002; Topor and Erin 2000). Professionals engaged in the selection of AT for a
student may find it useful to augment assessment findings on the student’s abilities
and support needs with information on students’, parents’, teachers’, and other
caretakers’ expectations and goals for the student’s functioning. Doing so may
involve interviews, review of Individualized Education Program documents for the
student, or formal instruments, such as the Expectations for Visual Functioning
(Corn and Webne 2001).
Given the diversity of technical expertise required for assessment and interpretation
of data on the abilities and support needs of students with VI and
blindness, the brainstorming of possible AT solutions may benefit from the
involvement of representatives from multiple disciplines (Faye 1996; Hyvarinen
2000; Koenig and Holbrook 1995; Sadao and Robinson 2010; Topor and Erin
2000; Van Hof and Looijestijn 1995). For example, optometrists have unique
expertise in refraction-based solutions (e.g., eyeglasses), certified low vision
specialists and teachers of students with VI likely have unique expertise in nonoptical
aids for vision, and the student’s teachers and parents likely have unique
insights regarding the practicality of implementing various forms of AT. Further,
the complementarity of AT selected for a student can be improved by including
professionals from multiple disciplines (Hyvarinen 2000). For example, for certain
students use of refractive magnifiers can problematically reduce the contrast of
reading materials (Cline et al. 1997). Should a teacher suggest use of a magnifying
glass due to its practicality, an optometrist could add the suggestion of outfitting
the magnifying glass with a colored film that enhances the contrast of reading
materials. Also, students with comorbid disabilities may require multiple, complementary
supports (e.g., vision, head position, and posture supports for students
with multiple disabilities; Friend 2011). In such cases, collaborations among
professionals, such as optometrists, occupational therapists, and teachers are likely
to lead to more effective and practically feasible solutions.
Conducting initial and on-going evaluations of the use of AT with students
facilitates determination of the adequacy of a student’s supports (Alberto and
Troutman 2012; Bryant and Bryant 2003; Cook and Hussey 2002). Since no
structured system exists for the selection of AT and implementation results vary
from person to person, the process typically begins with educated guesses as to
what would produce benefit for the student, based on review of assessment results
and the professionals’ prior experiences (Desch 2013). Evaluation of the adequacy
of identified AT and related supports should follow this guesswork. The evaluation
process should start with collection of baseline data on the student’s present levels
of functioning. Subsequently, data should be collected during test runs performed
in all settings in which the student will use the AT, to confirm the AT and any
additional supports provided are adequate. After making any adaptations to the
5 Assistive Technology for Students with Visual Impairments and Blindness 143
support plan and performing additional test runs, on-going evaluations should be
maintained to monitor the success of implementation and emergent needs of the
student. Use of single-subject research design methodology (e.g., operational
definitions of behavior, behavior counts, multiple baselines across settings) can
promote objectivity in evaluations (Kennedy 2005).
A final set of issues to consider in the selection of AT for students with VI and
blindness are their cultural norms and preferences (Sadao and Robinson 2010).
Across culture groups, norms and preferences may vary with regard to visual
behavior, play, care, and children’s rights (e.g., Salend and Taylor 2002; Xie
2009). To respond to a student’s culture and arrive at socially valid intervention
plans, professionals should engage families and students in the processes of
intervention plan development and implementation of AT.
Teaching and Encouraging Use of Assistive Technology
To encourage students’ use of AT, professionals, parents, and other caregivers
should (a) use evidence-based methods to teach and support skills for AT use,
(b) include goals and objectives for AT use in the students’ IEPs, (c) integrate
intervention into students’ preferred functional activities, and (d) provide complimentary
services that support the students’ AT use. Many forms of AT for
students with VI and blindness require specific skills for successful use. On-going
use of evidence-based methods for teaching and behavior support, such as direct
instruction, practice with feedback, shaping, and reinforcement of success, provides
the greatest likelihood students will acquire the requisite skills and maintain
the related behaviors (Alberto and Troutman 2012; Archer and Hughes 2011;
Sadao and Robinson 2010). To bolster efforts to teach skills for use of the AT, a
student’s IEP committee should include goals and objectives for AT use in his/her
IEP (Geddie et al. 2013; Friend 2011; Presley 2010). The potential value of doing
so derives from the committee’s articulation of what successful implementation of
the AT will include, commitment to on-going implementation and monitoring of
outcomes, and delineation of responsibilities for adapting the intervention plan as
necessary. Students’ success in use of AT may be enhanced by integrating intervention
into students’ preferred functional activities (Topor et al. 2004; Lueck and
Heinze 2004) and providing complimentary services (Cochrane et al. 2011; Ferrell
1996, 1985; Tavernier 1993; Topor and Erin 2000). Integration of intervention into
preferred functional activities can facilitate the student’s access of established and
preferred reinforcers, which may lead to increased use of the AT in the activity
context and beyond. Provision of complimentary services, such as medical treatment,
behavioral optometry/vision instruction, adaptation of the physical environment,
and orientation and mobility training, may enhance a student’s visual
functioning and improve outcomes of AT use, thereby enabling increased access to
natural reinforcers for AT use.
144 A. M. Mulloy et al.
Technology Abandonment
Roughly one-third of all recipients of AT have been found to abandon their devices
(Phillips and Zhao 1993). As stated above, abandonment of AT is associated with
reports that one’s needs were not fully identified and addressed during the AT
assessment and selection process (Cook 1982; Zola 1982). Frequently cited reasons
for AT abandonment have specifically included complaints that (a) the AT
did not enable satisfactory improvements in functioning, (b) use of the AT was
inconvenient, awkward, and/or socially stigmatizing, and (c) the AT was not
relevant to personal goals for improved functioning (Cook 1982; Day et al. 2001;
Phillips and Zhao 1993; Zola 1982). Professionals may be able to decrease the
likelihood of AT abandonment by making efforts during assessment, AT selection,
and phases of teaching and supporting AT use. For example, to maximize the
potential for improvements in functioning, professionals can (a) conduct initial
evaluations of the AT’s appropriateness and the student’s functioning with the AT
in all settings targeted for use prior to committing to implementation (Alberto and
Troutman 2012; Bryant and Bryant 2003; Cook and Hussey 2002), (b) provide
support for the student’s use of the AT with fidelity to the plan established (e.g., in
the student’s IEP; Geddie et al. 2013; Friend 2011; Presley 2010), (c) conduct ongoing
evaluations of the AT’s appropriateness and the student’s functioning with
the AT, and, if relevant, consider alternative forms of AT and/or additional
training and support for use of the AT (Alberto and Troutman 2012; Bryant and
Bryant 2003; Cook and Hussey 2002), and (d) provide treatment for any comorbid
disabilities or disorders to attenuate their impact on the student’s functionality and
use of the AT (Levack et al. 1994). To reduce any inconvenience, awkwardness, or
social stigma involved in AT use, professionals can (a) monitor these factors in
initial and on-going evaluations of the student’s functioning with the AT, and
(b) consult with the student and his/her family and teachers regarding the potential
for these experiences prior to implementing the AT (Day et al. 2001; Scherer
1998b). Also, to improve students’ perception of AT as relevant to their personal
goals for improved functioning, professionals can consult with the student and
his/her family prior to implementing the AT.
Authors have published several instruments that formalize these preventative
practices. The Assistive Technology Device Predisposition Assessment (Scherer
1998a; Scherer and Craddock 2002) structures the gathering of information on
students’ personal goals and, for a particular AT device, the potential for improved
functioning, inconvenience, awkwardness, and social stigma. Tools for assessing
students’ satisfaction with AT after beginning implementation include the Quebec
User Evaluation of Satifaction with Assistive Technology (Demers et al. 2002) and
the Psychosocial Impact of Assistive Devices Scale (Day et al. 2002; Jutai et al.
2005). Additionally, useful information may be generated by the vision-specific
quality of life measure Impact of Vision Impairment on Children (Cochrane et al.
2011).
5 Assistive Technology for Students with Visual Impairments and Blindness 145
Areas for Future Research
Areas for future research on AT and students with VI and blindness include (a) the
reliability and validity of AT assessment methods’ outcomes, (b) the efficacy of
various AT in improving students’ functioning, (c) students’ preferences for particular
AT supports, (d) the impact of provision of complimentary supports on
visual functioning and related behavior (e.g., vision instruction, environmental
modifications), (e) the effects of instruction on AT use, and (f) circumstances that
influence the fidelity of AT interventions’ implementation and the effectiveness of
interventions. Given the paucity of research in these areas and the value of
research findings to optimizing the education and development of students (IDEA
2004c), there is a great need for continued work in these areas.
References
AbilityNet (2007). Voice recognition for blind computer users. Retrieved March 15, 2013 from
http://www.abilitynet.org.uk/content/factsheets/pdfs/
Voice_Recognition_for_Blind_Computer_Users.pdf
Abner, G., & Lahm, E. (2002). Implementation of assistive technology with students who are
visually impaired: Teachers’ readiness. Journal of Visual Impairment and Blindness, 96(02),
98–105.
Adetoro, N. (2012). Alternative format preferences among secondary school visually impaired
student in Nigeria. Journal of Librarianship and Information Science, 44, 90–96.
Al Otaiba, S., Connor, C., Folsom, J., Greulich, L., Meadows, J., & Li, Z. (2011). Assessment
data-informed guidance to individualize kindergarten reading instruction: Findings from a
cluster-randomized control field trial. Elementary School Journal, 111, 535–560.
Alberto, P., & Troutman, A. (2012). Applied behavior analysis for teachers. Upper Saddle River:
Prentice Hall.
American Academy of Ophthalmology. (2002). Amblyopia. San Francisco: Author.
American Foundation for the Blind. (2013a). Glossary of eye conditions. Retrieved March 15,
2013 from http://www.afb.org/section.aspx?FolderID=2&SectionID=93
American Foundation for the Blind. (2013b). Reading tools. Retrieved March 15, 2013 from
http://www.visionaware.org/
section.aspx?FolderID=8&SectionID=115&TopicID=487&DocumentID=3254
American Foundation for the Blind. (2013c). Refreshable braille displays. Retrieved March 15,
2013 from http://www.afb.org/ProdBrowseCatResults.asp?CatID=43
American Foundation for the Blind. (2013d). Signing your name and handwriting if you are blind
or have low vision. Retrieved from http://www.afb.org/section.aspx?FolderID=8&SectionID=
115&TopicID=487&DocumentID=5840
American Foundation for the Blind. (2013e). Speech systems. Retrieved March 15, 2013 from
http://www.afb.org/
section.aspx?FolderID=2&SectionID=4&TopicID=31&DocumentID=1284
American Foundation for the Blind. (2013f). Tips for making print more readable. Retrieved
March 15, 2013 from http://www.afb.org/section.aspx?TopicID=200&DocumentID=210
AmericanFoundation for the Blind. (2013g). Writing tools for auditory readers. Retrieved
March 15, 2013 from http://www.afb.org/section.aspx?FolderID=2&SectionID=4&TopicID=
200&DocumentID=6252
146 A. M. Mulloy et al.
American Foundation for the Blind. (2013h). Writing tools for visual readers. Retrieved
March 15, 2013 from http://www.afb.org/section.aspx?FolderID=2&SectionID=4&TopicID=
200&DocumentID=6253
American Print House for the Blind. (2013). FVLMA Kit: Functional Vision and Learning Media
Assessment. Retrieved March 15, 2013 from http://shop.aph.org.
Angelocci, R. M., & Connors, B. G. (2002). Assessing writing software tools for people with
vision impairment, learning disability, and/or low literacy. Retrieved March 15, 2013 from
http://63.240.118.132/
Section.asp?SectionID=44&TopicID=108&SubTopicID=32&DocumentID=1936
Archer, A., & Hughes, C. (2011). Explicit instruction: Effective and efficient teaching. New York:
Guilford Press.
Atlick, R. (1998). The English common reader: A social history of the mass reading public,
1800–1900. Columbus: Ohio State University Press.
Attmore, M. (1990). Career perspectives: Interviews with blind and visually impaired
professionals. New York: American Foundation for the Blind.
Baillargeon, R. (1993). The object concept revisited: New directions in the investigation of
infants’ physical knowledge. In C. Granrud (Ed.), Visual perception and cognition in infancy.
Hillsdale: Erlbaum.
Bangor, A. W. (1998). Improving access to computer displays: Readability for visually impaired
users. Unpublished master’s thesis, Virginia Polytechnic Institute and State University,
Blacksburg, VA.
Beech, M., (2010). Accommodations: Assisting students with disabilities. Retrieved March 15,
2013 from http://www.fldoe.org/ese/pdf/accomm-educator.pdf
Belcastro, F. P. (1993). Teaching addition and subtraction of whole numbers to blind students:
A comparison of two methods. Focus on Learning Problems in Mathematics, 15(1), 14–22.
Bergwerk, K. (2011). Vision impairment. In D. Patel, D. Greydanus, H. Omar, & J. Merrick
(Eds.), Neurodevelopmental disabilities (pp. 277–296). New York: Springer.
Bishop, V. (2004). Teaching visually impaired children (3rd ed.). Springfield: Charles C Thomas.
Bosetti, M., Pilolli, P., Ruffoni, M., & Ronchetti, M. (2011). Interactive whiteboards based on the
WiiMote: Validation on the field . In 14th International Conference on Interactive
Collaborative Learning (ICL2011)—11th International Conference Virtual University (pp.
269–273). Kassel: Kassel University Press.
Bouck, E. C., Flanagan, S., Joshi, G. S., Sheick, W., & Schleppenbach, D. (2011). Speaking
math—A voice input, speech output calculator for students with visual impairments. Journal
of Special Education Technology, 26(4), 1–14.
Bowers, A. R., Meek, C., & Stewart, N. (2001). Illumination and reading performance in agerelated
macular degeneration. Clinical and Experimental Optometry, 84(3), 139–147.
Braille Note Users. (2012). Product comparisons between BrailleNote, Braille Sense and PAC
mate. Retrieved March 15, 2013 from http://www.braillenoteusers.info/articles/introductory_
material/pdacomp.php
Brandsborg, K. (1996). Congenital blindness and developmental risk: Early family intervention:
A Norwegian model. In C. de Jong & H. Neugebaur (Eds.), Timely intervention: Special Help
for Special Needs: International Conference in Bad Berleburg, November 26–December 2,
1995. Wurzberg, Germany: Bentheim.
Brilliant, R. (1999). Essentials of low vision practice. Boston: Butterworth-Heinemann.
Brodsky, M. (2010). Pediatric neuro-ophthalmology (2nd ed.). New York: Springer Publishing.
Bryant, D., & Bryant, B. (2003). Assistive technology for people with disabilities. Boston:
Pearson Education Inc.
Burnett, R., & Sanford, L. (2008). FVLMA Kit. Functional vision and learning media assessment.
Louisville: American Printing House for the Blind.
Bussell, L. (2003). Touch tiles: Elementary geometry software with a haptic and auditory
interface for visually impaired children. Retrieved March 15, 2013 from http://
www.eurohaptics.vision.ee.ethz.ch/2003/80.pdf
5 Assistive Technology for Students with Visual Impairments and Blindness 147
Campbell, J. S. (1997). A code for reducing figure-ground ambiguities in tactile graphics. Journal
of Visual Impairment and Blindness, 91(2), 175–181.
Caton, H. (1991). Print and Braille literacy: Selecting appropriate learning media. Louisville:
American Printing House for the Blind.
Center for Assistive Technology and Environmental Access [CATEA]. (2009). Accessible
calculators. Retrieved March 15, 2013 from http://atwiki.assistivetech.net/index.php/
Accessible_calculators
Champion, R. R. (1976/77). The talking calculator used with blind youth. Education of the
Visually Handicapped, 8(4), 102–106.
Chiang, M. F., Cole, R. G., Gupta, S., Kaiser, G. E., & Starren, J. B. (2005). Computer and world
wide web accessibility by visually disabled patients: Problems and solutions. Survey of
Ophthalmology, 50(4), 394–405.
Chou, R., Dana, T., & Bougatsos, C. (2011). Screening for visual impairment in children ages
1–5 years: Update for the USPSTF. Pediatrics, 127, e442–e479.
Cline, D., Hofstetter, H., & Griffin, J. (1997). Dictionary of visual science (4th ed.). Boston:
Butterworth-Heinemann.
Cochrane, G., Marella, M., Keefe, J., & Lamoureux, E. (2011). The impact of vision impairment
on children (IVI_C): Validation of a vision-specific pediatric quality-of-life questionnaire
using rasch analysis. Investigative Ophthalmology and Visual Science, 52, 1632–1640.
Collins, J. (2000). Homonymous hemianopia in the low vision clinic—which way to turn. In C.
Stuen, A. Arditi, A. Horowitz, M. A. Lang, B. Rosenthal, & K. Seidman (Eds.), Vision
rehabilitation: Assessment, intervention and outcomes (pp. 99–103). Lisse: Swets and
Zeitlinger.
Committee on Practice and Ambulatory Medicine Section on Ophthalmology, American
Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and
Strabismus, & American Academy of Ophthalmology. (2003). Eye examination in infants,
children and young adults by pediatricians. Pediatrics, 111, 902–907.
Conley, O., & Wolery, M. (1980). Treatment by overcorrection of self-injurious eye gouging in
preschool blind children. Journal of Behavioral Therapy and Experimental Psychiatry, 11,
121–125.
Cook, A., & Hussey, S. (2002). Assistive technologies: Principles and practice. St. Louis, MO:
Mosby.
Cook, A. (1982). Delivery of assistive devices through a client-oriented approach. In M. Redden
& V. Stern (Eds.), Technology for Independent Living II: Issues in Technology for Daily
Living, Education and Employment (pp. 29–31). Washington, DC: American Association for
the Advancement of Science.
Cooper, H. (2007). Nemeth braille translation technology. SenseAbilities, 1(3). Retrieved March
15, 2013 from http://www.tsbvi.edu/resources/433-nemeth-braille-translation-technology
Corn, A. L. (1990). Optical devices or large-type: Is there a debate? In A. W. Johnston &
M. Lawrence (Eds.), Low vision ahead II (pp. 247–253). New York: Association for the Blind.
Corn, A. L., & Webne, S. L. (2001). Expectations for visual function: An initial evaluation of a
new clinical instrument. Journal of Visual Impairment and Blindness, 95(2), 110–116.
Crossan, A., & Brewster, S. (2008). Multimodal trajectory playback for teaching shape
information and trajectories to visually impaired computer users. ACM Transactions on
Accessible Computing, 1(2), 12.
Davidson, S., & Quinn, G. (2011). The impact of pediatric vision disorders in adulthood.
Pediatrics, 127, 334–339.
Day, H., Jutai, J., & Campbell, K. (2002). Development of a scale to measure the psychosocial
impact of assistive devices: Lessons learned and the road ahead. Disability and Rehabilitation,
24, 31–37.
Day, H., Jutai, J., Woolrich, W., & Strong, G. (2001). The stability of impact of assistive devices.
Disability and Rehabilitation, 23, 400–404.
De Castell, S., Luke, A., & Egan, K. (1986). Literacy, society, and schooling. New York:
Cambridge University Press.
148 A. M. Mulloy et al.
DeMario, N. C. (2000). Teachers’ perceptions of need for and competency in transcribing braille
materials in the Nemeth code. Journal of Visual Impairment and Blindness, 94(1), 7–14.
Demers, L., Weiss-Lambrou, R., & Ska, B. (2002). The Quebec user evaluation of satisfaction
with assistive technology (QUEST 2.0). Technology and Disability, 14, 101–105.
Desch, L. (2013). Assistive technology. In M. Batshaw, N. Roizen, & G. Latrecchiano (Eds.),
Children with disabilities (7th ed., pp. 169–188). Baltimore: Brookes Publishing Inc.
Dick, T., & Kubiak, E. (1997). Issues and aids for teaching mathematics to the blind. The
Mathematics Teacher, 90(4), 344–349.
Disabilities, Opportunities, Internetworking, & Technology Center. (2013a). What are tactile
graphics. Retrieved March 15, 2013 from http://www.washington.edu/doit/Faculty/
articles?464
Disabilities, Opportunities, Internetworking, & Technology Center. (2013b). What is Braille
translation software. Retrieved March 15, 2013 from http://www.washington.edu/doit/
Faculty/articles?466
Earl, C., & Leventhal, J. D. (1997). Windows 95 access for blind or visually impaired persons:
An overview. Journal of Visual Impairment and Blindness, 91(5), 5–9.
Earl, C., & Leventhal, J. D. (1999). A survey of Windows screen reader users: Recent
improvements in accessibility. Journal of Visual Impairment and Blindness, 93, 247–251.
Emerson, R. W., Corn, A., & Siller, M. A. (2006). Trends in Braille and large-print production in
the United States: 2000–2004. Journal of Visual Impairment and Blindness, 100(3), 137–151.
Eperjesi, F., Maiz-Fernandez, C., & Bartlett, H. E. (2007). Reading performance with various
lamps in age-related macular degeneration. Ophthalmic and Physiological Optics, 27(1),
93–99.
Erickson, V. (2004). Spotlight on assistive technology. Media and Methods, 40(5), 4.
Erin, J. (1996). Assessment and instruction for children with multiple disabilities. In A. Corn &
A. Koenig (Eds.), Foundations of low vision: Clinical and functional perspectives
(pp. 221–245). New York: American Foundation for the Blind.
Erin, J. N., & Paul, B. (1996). Functional vision assessment and instruction of children and youths
in academic programs. In A. L. Corn & A. J. Koenig (Eds.), Foundations of low vision:
Clinical and functional perspectives (pp. 185–220). New York: American Foundation for the
Blind.
Evans, D. G., & Blenkhorn, P. (2004). Producing preferred format material from Microsoft word.
IEEE Transactions on Neural Systems and Rehabilitation Engineering: A Publication of The
IEEE Engineering in Medicine and Biology Society, 12(3), 325–330.
Evans, D. G., Diggle, T., Kurniawan, S. H., & Blenkhorn, P. (2003). An investigation into
formatting and layout errors produced by blind word-processor users and an evaluation of
prototype error prevention and correction techniques. IEEE Transactions an Neural Systems
and Rehabilitation Engineering: A Publication of the IEEE Engineering in Medicine and
Biology Society, 11(3), 257–268.
Farmer, J., & Morse, S. E. (2007). Project magnify: Increasing reading skills in students with low
vision. Journal of Visual Impairment & Blindness, 101(12), 763–768.
Faye, E. (1984). Clinical low vision (2nd ed.). Boston: Little Brown.
Faye, E. (1996). Pathology and visual function. In B. Rosenthal & R. Cole (Eds.), Functional
assessment of low vision (pp. 63–76). St. Louis, MO: Mosby.
Fazzi, E., Lanners, J., Danova, S., Ferrarri-Ginevra, O., Gheza, C., Luparia, A., et al. (1999).
Stereotyped behaviours in blind children. Brain Development, 8, 522–528.
Ferrell, K. (1985). Reach out and teach: Meeting the training needs of parents of visually and
multiply handicapped young children. New York: American Foundation for the Blind.
Ferrell, K. (1996). A call to end vision stimulation training. Journal of Visual Impairment and
Blindness, 60, 364–365.
Ferrell, K. (2006). Evidence-based practices for students with visual disabilities. Communication
Disorders Quarterly, 28, 42–48.
Frailberg, S. (1977). Insights from the blind: Comparative studies of blind and sighted infants.
New York: Perseus Books Group.
5 Assistive Technology for Students with Visual Impairments and Blindness 149
Friend, M. (2011). Special education: Contemporary perspectives for school professionals (3rd
ed.). Boston: Allyn and Bacon.
Galvin, J., & Scherer, M. (Eds.). (2004). Evaluating, selecting, and using appropriate assistive
technology. Austin: Pro-Ed.
Gardner, A. (1996). Tactile graphics, an overview and resource guide. Retrieved March 15, 2013
from http://dots.physics.orst.edu/tactile/tactile.html
Geddie, B., Bina, M., & Miller, M. (2013). Vision and vision impairment. In M. Batshaw, N.
Roizen, & G. Latrecchiano (Eds.), Children with disabilities (7th ed., pp. 169–188).
Baltimore: Brookes Publishing Inc.
Gerritsen, B. (2001). Illuminating thoughts on popular low vision task lamps. AccessWorld, 2(5).
Retrieved March 15, 2013 from http://www.afb.org/afbpress/pub.asp?DocID=aw020504
Gibson, W. E., & Darron, C. (1999). Teaching statistics to a student who is blind. Teaching of
Psychology, 26(2), 130–131.
Goodrich, G. L., & Kirby, J. (2001). A comparison of patient reading performance and
preference: Optical devices, handheld CCTV (Innoventions Magni-Cam), or stand-mounted
CCTV (Optelec Clearview or TSI Genie). Optometry: Journal of the American Optometric
Association, 72(8), 519–528.
Goodrich, G., Mehr, E., & Darling, N. (1980). Parameters in the use of CCTV’s and optical aids.
American Journal of Optometry, Physiology, and Ophthalmology, 57, 881–892.
Gothwal, V. K., & Herse, P. (2000). Characteristics of a paediatric low vision population in a
private eye hospital in India. Ophthalmic and Physiological Optics, 20(3), 212–219.
Goudiras, D. B., Papadopoulos, K. S., Koutsoklenis, A. C., Papageorgiou, V. E., & Stergiou, M.
S. (2009). Factors affecting the reading media used by visually impaired adults. British
Journal of Visual Impairment, 27(2), 111–127.
Graff, H. (1978). Literacy past and present: Critical approaches in the literacy/society
relationship. Interchange, 9, 1–21.
Groenendaal, F., & Van Hof-Van Duin, J. (1992). Visual deficits and improvements in children
after perinatal hypoxia. Journal of Visual Impairment and Blindness, 86, 215–218.
Harper, R., Culham, L., & Dickinson, C. (1999). Head mounted video magnification devices for
low vision rehabilitation: A comparison with existing technology. British Journal of
Ophthalmology, 83, 495–500.
Hatton, D. (2001). Model registry of early childhood visual impaired collaborative group: First
year results. Journal of Blindness and Visual Impairments, 95, 418–433.
Hatton, D., Bailey, D., Burchinal, J., & Ferell, K. (1997). Developmental growth curves of
preschool children with vision impairments. Child Development, 68, 788–806.
Holbrook, M. (2006). Children with visual impairments: A guide for parents. Bethesda:
Woodbine House.
Houwen, S., Hartman, E., & Visscher, C. (2010). The relationship among motor proficiency,
physical fitness, and body composition in children with and without visual impairments.
Research Quarterly Exercise in Sport, 81, 290–299.
Huebner, K. M. (2000). Visual Impairment. In C. M. Holbrook & A. J. Koenig (Eds.),
Foundations of education (2nd ed.). New York: American Foundation for the Blind.
Hughes, L. E., & Wilkins, A. J. (2002). Reading at a distance: Implications for the design of text
in children’s big books. British Journal of Educational Psychology, 72(2), 213–226.
Hyvarinen, L. (2000). Functional diagnosis and assessment of vision impairment. In B.
Silverstone, M. Lang, B. Rosenthal, & E. Faye (Eds.), The lighthouse handbook on vision
impairment and vision rehabilitation (Vol. 2, pp. 799–820). New York: Oxford University
Press.
Illinois State Univeristy (2012). SMART Boards for visually impaired. Retrieved March 15, 2013
from http://mediarelations.illinoisstate.edu/report/1213/july3/smartboards.asp
Independence Science. (2013a). Access technology. Retrieved March 15, 2013 from http://
www.independencescience.com/access-technology.php
Independence Science. (2013b). Tactile solutions. Retrieved March 15, 2013 from http://
www.independencescience.com/tactile-solutions.php
150 A. M. Mulloy et al.
Individuals with Disabilities Education Improvement Act of 2004, 20 C.F.R.
§1414(d)(3)(B)(iii)(2004a).
Individuals with Disabilities Education Improvement Act of 2004, 20 C.F.R. §300.8(c)(l3)
(2004b).
Individuals with Disabilities Education Improvement Act of 2004, 20 USC 1400, P.L. No.
108–446 (2004c).
IRIS Center for Training Enhancements. (2012). Accommodations to the physical environment:
Setting up a classroom for students with visual disabilities. Retrieved March 15, 2013 from
http://iris.peabody.vanderbilt.edu/v01_clearview/v01_05.html
Iwata, B., Pace, G., Dorsey, M., Zarcone, J., Vollmer, T., Smith, R., et al. (1994). The functions
of self-injurious behavior: An experimental-epidemiological analysis. Journal of Applied
Behavior Analysis, 27, 215–240.
Jan, J. E., Freeman, R. D., & Scott, E. P. (1977). Visual impairment in children and adolescents.
Philadelphia, PA: Grune & Stratton.
Jayant, C. (2006). A survey of math accessibility for blind persons and an investigation on text/
math separation. Seattle: University of Washington.
Jones, M., Minoque, J., Oppewal, T., Cook, M., & Broadwell, B. (2006). Visualizing without
vision at the microscale: Students with visual impairments explore cells with touch. Journal of
Science Education and Technology, 15, 345–351.
Jutai, J., Fuhrer, M., Demer, L., Scherer, M., & DeRuyter, F. (2005). Towards a taxonomy of
assistive technology device outcomes. American Journal of Physical Medicine and
Rehabilitation, 84, 284–302.
Kamei-Hannan, C. (2008). Examining the accessibility of a computerized adapted test using
assistive technology. Journal of Visual Impairment and Blindness, 102(5), 261–271.
Kapperman, G. G. (1974). A comparison of three methods of arithmetic computation by the
blind. Dissertation Abstracts International, 35(05), 2810A.
Karat, C., Halverson, C., Horn, & Karat, J., (1999). Patterns of entry and correction in large
vocabulary continuous speech recognition systems. Paper presented at the CHI conference,
Pittsburgh, PA.
Karshmer, A. I., & Bledsoe, C. (2002). Access to mathematics by blind students. In J. Klaus, K.
Miesenberger, & W. Zagler (Eds.), Computers helping people with special needs
(pp. 471–476). Berlin, Germany: Springer.
Karshmer, A. I., & Farsi, D. (2008). Manipulatives in the history of teaching: Fast forward to
AutOMathic blocks for the blind. In J. Klaus, K. Miesenberger, & W. Zagler (Eds.),
Computers helping people with special needs (pp. 915–918). Berlin: Springer.
Kennedy, C. (2005). Single-case designs for educational research. Boston: Allyn & Bacon.
Khan, S. A., Aasuri, M. K., & Nutheti, R. (2003). Low vision care in patients with amblyopia
following surgery for childhood cataract in India. Visual Impairment Research, 5(2), 73–82.
Kirchner, C., & Diamant, S. (1999). Estimate of number of visually impaired students, their
teachers, and orientation and mobility specialists: Part 1. Journal of Visual Impairment and
Blindness, 93, 600–606.
Kitchel, J. E. (2013). APH Guidelines for print document design. Retrieved March 15, 2013 from
http://www.aph.org/edresearch/lpguide.htm
Koenig, A. (1999). Development and dissemination of a multimedia instructional package for use
in preservice and inservice training to address selection of appropriate literacy media for
students with visual impairments. Project LMA final report. Lubbock: Texas Tech University.
Koenig, A. & Holbrook, C. (1995). Project LMA: Learning media assessment of students with
visual impairments. facilitator’s manual and participant workbook. Austin, TX: Texas School
for the Blind and Visually Impaired.
Koenig, A., & Holbrook, C. (2000). Ensuring high-quality instruction for students in Braille
literacy programs. Journal of Visual Impairment and Blindness, 94(11), 677–690.
Koenig, A. J., Layton, C. A., & Ross, D. B. (1992). The relative effectiveness of reading in large
print and with low vision devices for students with low vision. Journal of Visual Impairment
and Blindness, 86(1), 48–53.
5 Assistive Technology for Students with Visual Impairments and Blindness 151
Koestler, F. (2004). The unseen minority: A social history of blindness in the United States.
New York: American Foundation for the Blind.
Krufka, S. E., & Barner, K. E. (2006). A user study on tactile graphic generation methods.
Behaviour & Information Technology, 25(4), 297–311.
La Voy, C. L. (2009). Mathematics and the visually impaired child: An examination of standardsbased
mathematics teaching strategies with young visually impaired children. (Doctoral
dissertation). Retrieved from ProQuest Dissertations and Thesis (PQDT) database.
(304910651).
Lalli, J., Livezey, K., & Kates, K. (1996). Functional analysis and treatment of eye poking with
response blocking. Journal of Applied Behavior Analysis, 29, 129–132.
Landau, S., Russell, M., Gourgey, K., Erin, J., & Cowan, J. (2003). Use of the talking tactile
tablet in mathematics testing. Journal of Visual Impairment and Blindness, 97(2), 85–96.
Langley, M. B. (1998). ISAVE: Individualized systematic assessment of visual efficiency.
Louisville, KY: American Printing House for the Blind.
Lazar, J., Allen, A., Kleinman, J., & Malarkey, C. (2007). What frustrates screen reader users on
the web: A study of 100 blind users. International Journal of Human-Computer Interaction,
22(3), 247–269.
Levack, N., Stone, G., & Bishop, V. (1994). Low vision: A resource guide with adaptations for
students with visual impairments. Austin: Texas School for the Blind and Visually Impaired.
Lindner, H., Rinnert, T., & Behrens-Baumann, W. (2001). Illumination conditions of visually
impaired people under private domestic circumstances-clinical study on 91 patients. Klinische
Monatsblatter fur Augenheilkunde, 218(12), 774–781.
LiveScience. (2013). New creates freedom for the visually impaired researcher. Retrieved March
15, 2013 from http://www.livescience.com/24522-independent-science-research-solutionsnsf-bts.html
Lovie-Kitchin, J. E., Bevanm, J. D., & Hein, B. (2001). Reading performance in children with
low vision. Clinical and Experimental Optometry, 84(3), 148–154.
Lueck, A., & Heinze, T. (2004). Interventions for young children with visual impairments and
students with visual and multiple disabilities. In A. Lueck (Ed.), Functional vision:
A practitioner’s guide to evaluation and intervention. American Foundation for the Blind:
New York, NY.
Lueck, A. H., Bailey, I. L., Greer, R. B., Tuan, K. M., Bailey, V. M., & Dornbusch, H. G. (2003).
Exploring print-size requirements and reading for students with low vision. Journal of Visual
Impairment and Blindness, 97(6), 335–354.
Lusk, K. E. (2012). The effects of various mounting systems of near magnification on reading
performance and preference in school-age students with low vision. British Journal Of Visual
Impairment, 30(3), 168–181.
Majerus, W. (2011). Access to electronic books: A comparative review. The Braille Monitor,
54(5). Retrieved from https://nfb.org/images/nfb/publications/bm/bm11/bm1105/
bm110509.htm
Mason, C., Davidson, R., & McNerney, C. (2000). National plan for training personnel to serve
children with blindness and low vision. Reston: The Council for Exceptional Children.
Matta, N., Singman, E., & Silbert, D. (2010). Evidenced-based medicine: Treatment of
amblyopia. American Orthopetic Journal, 60, 17–22.
McLeish, E. (2007). A study of the effect of letter spacing on the reading speed of young readers
with low vision. British Journal of Visual Impairment, 25(2), 133–143.
Mehr, E., Frost, A., & Apple, L. (1973). Experience with closed circuit television in the blind
rehabilitation program of the Veterans’ administration. American Journal of Optometry and
Archives of the American Academy of Optometry, 50, 458–469.
Mervis, C., Yeargin-Allsopp, M., Winter, S., & Boyle, C. (2000). Aetiology of childhood vision
impairment, metropolitan Atlanta, 1991–1993. Paediatric and Perinatal Epidemiology, 14,
70–77.
152 A. M. Mulloy et al.
Michaels, C. A., Prezant, F. P., Morabito, S. M., & Jackson, K. (2002). Assistive and instructional
technology for college students with disabilities: A national snapshot of postsecondary service
providers. Journal of Special Education Technology, 17(1), 5–14.
Microsoft. (2013). Helpful feature for JAWS in the Word spelling checker. Retrieved March 15,
2013 from http://office.microsoft.com/en-us/word-help/helpful-feature-for-jaws-in-the-wordspelling-checker-HA010269453.aspx
Mills, M. (1999). The eye in childhood. American Family Physician, 60, 907–918.
Multi-ethnic Pediatric Eye Disease Study Group. (2008). Prevalence of amblyopia and strabismus
in African-American and Hispanic children ages 6 to 72 months: The multi-ethnic pediatric
eye disease study. Ophthalmology, 115, 1229–1236.
National Association of Special Education Teachers. (2013). Teaching strategies for students
with visual impairments. Retrieved March 15, 2013 from http://www.naset.org/
visualimpairments2.0.html
Newcombe, S. (2010). CEU Article. The reliability of the CVI range: A functional vision
assessment for children with cortical visual impairment. Journal Of Visual Impairment and
Blindness, 104(10), 637–647.
Nicohls, S. (2013). Overview of technology for visually impaired and blind students. Retrieved
March 15, 2013 from http://tsbvi.edu/resources/1074-overview-of-technology-for-visuallyimpaired-and-blind-students
Nolan, C. Y., & Morris, J. E. (1964). The Japanese abacus as a computational aid for blind
children. Exceptional Children, 31, 15–17.
Norris, S., & Phillips, L. (2003). How literacy in its fundamental sense is central to scientific
literacy. Science Education, 87, 224–240.
Oldham, J., & Steiner, G. (2010). Being legally blind: Observations for parents of visually
impaired children. Anchorage: Shadow Fusion.
Orbit Research. (2013). Orbit Research and APH introduce the world’s first handheld talking
graphic calculator. Retrieved March 15, 2013 from http://www.aph.org/newsrel/
20130226Talking-Graphing-Calculator.html
Ortiz, A., Chung, S., Legge, G., & Jobling, J. (1999). Reading with a head-mounted video
magnifier. Optometry and Vision Science, 76, 755–763.
Ostensjo, S., Bjorbaekmo, W., Carlberg, E., & Vollestad, N. (2006). Assessment of everyday
functioning young children with disabilities: An ICF-based analysis of concepts and content
of the pediatric evaluation of disability inventory (PEDI). Disability and Rehabilitation, 28,
489–504.
Osterhaus, S. A. (2002). Susan’s math technology corner: The accessible graphing calculator
(AGC) from viewplus software. Division on Visual Impairments Quarterly, 47(2), 55–58.
Osterhaus, S. A. (2011). The use of manipulatives as an instructional strategy to help students
who are blind or visually impaired understand and learn math concepts (early childhood
through secondary) [PowerPoint slides]. Retrieved March 15, 2013 from http://
www.pathstoliteracy.org/sites/default/files/uploaded-files/Manipulatives.pdf
Perez-Pereira, M., & Conti-Ramsden, G. (1999). Language development and social interaction in
blind children. Philadelphia: Psychology Press.
Peterson, R., Wolffsohn, J., Rubinstein, M., & Lowe, J. (2003). Benefits of electronic vision
enhancement systems (EVES) for the visually impaired. American Journal of Ophthalmology,
136, 1129–1135.
Phillips, B., & Zhao, H. (1993). Predictors of assistive technology abandonment. Assistive
Technology, 5, 36–45.
Ponchillia, P. E., & Ponchillia, S. K. (1996). Foundations of rehabilitation teaching with persons
who are blind or visually impaired. New York: American Foundation for the Blind Press.
Presley, I. (2010). The impact of assistive technology: Assessment and instruction for children
and youths with low vision. In A. Corn & J. Erin (Eds.), Foundations of low vision: Clinical
and functional perspectives (2nd ed., pp. 589–654). New York: American Foundation for the
Blind.
5 Assistive Technology for Students with Visual Impairments and Blindness 153
Presley, I., & D’Andrea, F. M. (2009). Assistive technology for students who are blind or visually
impaired: A guide to assessment. New York: American Foundation for the Blind Press.
Rex, E. J., Koenig, A. J., Wormsley, D., & Baker, R. (1994). Foundations of braille literacy. New
York: American Foundation for the Blind.
Roman-Lantzy, C. (2007). Cortical visual impairment: An approach to assessment and
intervention. New York: American Foundation for the Blind.
Rosenblum, L. P., & Amato, S. (2004). Preparation in and Use of the Nemeth Braille Code for
Mathematics by Teachers of Students with Visual Impairments. Journal of Visual Impairment
and Blindness, 98(8), 484–498.
Rosenblum, L. P., & Herzberg, T. (2011). Accuracy and techniques in the preparation of
mathematics worksheets for tactile learners. Journal of Visual Impairment and Blindness,
105(7), 402–413.
Rosenthal, B., & Williams, D. (2000). Devices primarily for people with low vision. In B.
Silverstone, M. Lang, B. Rosenthal, & E. Faye (Eds.), The lighthouse handbook on vision
impairment and vision rehabilitation (Vol. 2, pp. 799–820). New York: Oxford University
Press.
Roth, G., & Fee, E. (2011). The invention of Braille. American Journal of Public Health, 101,
454.
Royal National Institute for the Blind. (2011). Teaching maths to pupils with vision impairment.
Retrieved March 15, 2013 from http://www.pathstoliteracy.org/math-literacy/content/
resources/teaching-maths-pupils-vision-impairment
Rule, A., Stefanich, G., Boody, R., & Peiffer, B. (2011). Impact of adaptive materials on teachers
and their students with visual impairments in secondary science and mathematics classes.
International Journal of Science Education, 33, 865–887.
Russotti, J., Shaw, R., & Spungin, S. J. (2004). When you have a visually impaired student in your
classroom: A guide for paraeducators. New York: American Foundation for the Blind Press.
Ryles, R. N. (1997). The relationship of reading medium to the literacy skills of high school
students who are visually impaired. (Doctoral dissertation, University of Washington, 1997).
Dissertation Abstracts International, 58, 4616.
Ryles, R., & Bell, E. (2009). Participation of parents in the early exploration of tactile graphics by
children who are visually impaired. Journal of Visual Impairment and Blindness, 103(10),
625–634.
Sadao, K. & Robinson, N. (2010). Assistive technology for young children: Creating inclusive.
Learning environments. Baltimore, MD: Brookes.
Salend, S., & Taylor, L. (2002). Cultural perspectives: Missing pieces in the functional
assessment process. Intervention in School and Clinic, 38, 104–112.
Scherer, M., & Craddock, G. (2002). Matching person and technology (MPT) assessment process.
Technology and Disability, 14, 125–131.
Scherer, M. (1998a). Matching person and technology model and accompanying assessment
forms (3rd ed.). Webster: Institute of Matching Person and Technology.
Scherer, M. (1998b). The impact of assistive technology on the lives of people with disabilities.
In D. Gray, L. Quatrano, & M. Lieberman (Eds.), Designing and using assistive technology:
The human perspective (pp. 99–115). Baltimore: Brookes Publishing Inc.
Schneiderman, B. (2000). The limits of speech recognition. Communications of the ACM, 43(9),
63–65.
Schoch, C. S. (2011). Teacher variations when administering math graphics items to students
with visual impairments. (Doctoral dissertation). Retrieved from ProQuest Dissertations and
Thesis (PQDT) database. (3434384).
Scholastic. (2013) SMART Technologies case study: Imperial elementary, Anaheim Hills,
California. Retrieved March 15, 2013 from http://www.scholastic.com/browse/article.
jsp?id=3748726
Schroeder, F. K. (1996). Perceptions of Braille usage by legally blind adults. Journal of Visual
Impairment and Blindness, 90(3), 210–218.
154 A. M. Mulloy et al.
Schwartz, T., Hyvarinen, L., & Appleby, K. (1997). Pediatric vision testing: Examining normal
and visually impaired children [Videotape]. Morgantown: West Virginia University.
Senge, J. (1998). Building a bridge to college success in K-12. Los Angeles: Paper presented at
the California State University-Northridge annual meeting.
Shaaban, S., El-Lakkany, A. R., Swelam, A., & Anwar, G. (2009). Low vision aids provision for
visually impaired Egyptian patients—A clinical cutcome. Middle East African Journal of
Ophthalmology, 16(1), 29.
Shaw, R., Russotti, J., Strauss-Schwartz, J., Vail, H., & Kahn, R. (2009). The need for a uniform
method of recording and reporting functional vision assessments. Journal of Visual
Impairment and Blindness, 103(6), 367–371.
Smarttech. (2005). A schoolwide installation of whiteboards. Media and Methods, 41(5), 36.
Smith, D. W., & Smothers, S. M. (2012). The role and characteristics of tactile graphics in
secondary mathematics and science textbooks in nraille. Journal of Visual Impairment and
Blindness, 106(9), 543–554.
Sodnik, J., Jakus, G., & Tomazˇic, S. (2012). The use of spatialized speech in auditory interfaces
for computer users who are visually impaired. Journal of Visual Impairment and Blindness,
106(10), 634–645.
Spector, R. (1990). Visual fields. In H. Walker, W. Hall, & J. Hurst (Eds.), Clinical methods: The
history, physical, and laboratory examinations (3rd ed., pp. 565–572). Boston: Butterworths.
Spindler, R. (2006). Teaching mathematics to a student who is blind. (2006). Teaching
Mathematics and its Applications, 25(3), 120–126.
Spungin, S. J. (1990). Braille literacy: Issues for blind persons, families, professionals, and
producers of Braille. New York: American Foundation for the Blind.
Stefanik, B. (2012). Resources for visually impaired writers. Writer, 125, 9.
Stelmack, J., Reda, D., Ahlers, S., Bainbridge, L., & McCray, J. (1991). Reading performance of
geriatric patients post-exudative maculopathy. Journal of the American Optometry Association,
62, 53–57.
Stephens, O. (1989). Braille–Implications for living. Journal of Visual Impairment and Blindness,
83, 288–289.
Supalo, C., Kreuter, R., Musser, A., Han, J., Briody, J., McArtor, C., et al. (2006). Seeing
chemistry through sound: A submersible audible light sensor for observing chemical reactions
for students who are blind or visually impaired. Assistive Technology Outcomes and Benefits,
3, 110–116.
Sykes, K. C. (1971). A comparison of the effectiveness of standard print and large print in
facilitating the reading skills of visually impaired students. Education of the Visually
Handicapped, 3(4), 97–105.
Tavernier, G. (1993). The improvement of vision by vision stimulation and training: A review of
the literature. Journal of Visual Impairment and Blindness, 87, 143–148.
Taylor, A. (2001). Choosing your Braille embosser. The Braille Monitor, 44(9). Retrieved from
https://nfb.org/Images/nfb/Publications/bm/bm01/bm0110/bm011007.htm
Theoret, H., Merabet, L., & Pascual-Leone, A. (2004). Behavioral and neuroplastic changes in the
blind: Evidence for functionally relevant cross-modal interactions. Journal of Physiology, 98,
221–233.
Topor, I., & Erin, J. (2000). Educational assessment of vision function in infants and children. In
B. Silverstone, M. Lang, B. Rosenthal, & E. Faye (Eds.), The lighthouse handbook on vision
impairment and vision rehabilitation (Vol. 2, pp. 821–831). New York: Oxford University
Press.
Topor, I., Lueck, A., & Smith, J. (2004). Compensatory instruction for academically oriented
students with visual impairments. In A. Lueck (Ed.), Functional vision: A practitioner’s guide
to evaluation and intervention. American Foundation for the Blind: New York, NY.
US Preventative Services Task Force. (2011). Vision screening for children 1 to 5 years of age:
US preventative serves tak force recommendation statement. Pediatrics, 127, 340–346.
Uslan, M., Shen, R., & Shragai, Y. (1996). The evolution of video magnification technology.
Journal of Visual Impairment and Blindness, 90, 465–478.
5 Assistive Technology for Students with Visual Impairments and Blindness 155
Utely, B., Duncan, D., Strain, P., & Scanlon, K. (1983). Effect of contingent and noncontingent
vision stimulation on visual fixation in multiply handicapped children. Journal of the
Association of Persons with Severe Handicaps, 8, 29–42.
Van Geem, P. (2012). Computer generated tactile graphics. Retrieved March 15, 2013 from
http://www.tsbvi.edu/component/content/article/107-graphics/3189-tactile-graphicsresources_Computer_Generated_Tactile_Graphics
Van Hof, C., & Looijestijn, P. (1995). An interdisciplinary model for the rehabilitation of visually
impaired and blind people: Application of the ICIDH concepts. Disability Rehabilitation, 17,
391–399.
Van Scoy, F., McLaughlin, D., & Fullmer, A. (2005). Auditory augmentation of haptic graphs:
Developing a graphic tool for teaching pre-calculus skill to blind students. In Proceedings of
ICAD 05 Eleventh Meeting of the International Conference on Auditory Display, Limerick,
Ireland.
Vernier Software and Technology. (2013). Logger pro. Retrieved March 15, 2013 from http://
www.vernier.com/products/software/lp
Walker, B. N., & Nees, M. A. (2005). An agenda for research and development of multimodal
graphs. In Proceedings of ICAD 05, Eleventh Meeting of the International Conference on
Auditory Display, Limerick, Ireland. Retrieved March 15, 2013, from http://
sonify.psych.gatech.edu/ags2005/pdf/AGS05_WalkerNees.pdf
Walker, B., N., & Lowey, M. (2004). Sonification Sandbox: A graphical toolkit for auditory
graphs. Presented at Rehabilitation Engineering and Assistive Technology Society of
America (RESNA) 27th International Conference, Orlando, FL.
Watson, G., De L’Aune, W., Stelmack, J., Maino, J., & Long, S. (1997). National survey of the
impact of low vision device use among veterans. Optometry and Vision Science, 74, 249–259.
Willingham, W. W., Ragosta, M., Bennett, R. E., Braun, H., Rock, D. A., & Powers, D. E. (1988).
Testing handicapped people. Needham Heights: Allyn and Bacon.
Wolffsohn, J. C., & Peterson, R. (2003). A review of current knowledge on electronic vision
enhancement systems for the visually impaired. Ophthalmic and Physiological Optics, 23(1),
35–42.
Wong, V., Au-Yeung, Y., & Law, P. (2005). Correlation of functional independence measure for
children (WeeFIM) with developmental language tests in children with developmental delay.
Journal of Child Neurology, 20, 613–616.
World Health Organization. (2001). International classification of functioning, disability, and
health (ICF). Geneva: Author.
Xie, X. (2009). Why are students quiet? Looking at the Chinese context and beyond, ELT Journal,
64, 10–20.
Zola, I. (1982). Involving the consumer in the rehabilitation process: Easier said than done. In M.
Redden & V. Stern (Eds.), Technology for independent living II: Issues in technology for daily
living, education and employment (pp. 112–121). Washington, DC: American Association for
the Advancement of Science.
