We have placed three stars (***) at the beginning of each article to enable the use of your search features so that you may easily jump from article to article. ***Cover page Volume 2 Number 2 Spring 2009 AER Journal: Research and Practice in Visual Impairment and Blindness A quarterly journal in the field of education and rehabilitation of persons of all ages with low vision or blindness Cover image: Louis Braille Bicentennial Icon courtesy of National Braille Press  National Braille Press commissioned artist Judith Krimski to design an icon of Louis Braille to celebrate the bicentennial of his birth on January 4, 2009. The challenge was to illustrate Louis Braille’s vitality today while honoring his place in history. Krimski chose the silhouette, a common form of French portraiture two hundred years ago (prior to the invention of the camera). Skilled artists made silhouettes by looking at a subject’s profile, or side view, and cutting out just the outline of the face, freehand, on black paper. Within minutes, the artist could produce an image with a remarkable resemblance to the contours of the face of his subject. (Even today, iPod commercials portray silhouetted figures dancing to the music they’re listening to on their iPods.) But to capture Louis Braille’s genius, Krimski ignited a “fire in his head” by painting Louis’s naturally curly locks in vibrant colors—orange, purple, lime, teal—giving the image a decidedly current look. The space between his head and formal collar suggests a cravat, a long-strip neckband and forerunner to the necktie. ***Advertisement Growing My Way, Parts 1 & 2 A continuing DVD Series on the Developmental Impact of Visual Impairment This 2-DVD set tracks the development of five toddlers form birth to 36 months of age. It is an invaluable comparative reference that shows how children with typical vision, low vision and significantly impaired vision learn, adapt and grow at different development stages. “Provides an excellent overview of the impact that a variety of visual impairments can have on early development and that the adaptations children, parents and practitioners can use…” Janie Blome, Director of Field Services, American Printing House for the Blind “VIPS has done a great job…they’ve managed to present the scenarios from a positive viewpoint.” Virginia Bishop, Ph.D., (Retired) Adjunct Professor, University of Texas at Austin, Texas Tech University and Stephen F. Austin University “Shows the magic of the bond created between an infant and the world, regardless of visual function.” Paul J. Rychwalski, M.D., Pediatric Ophthalmologist VIPS Visually Impaired Preschool Services Greater Louisville 1906 Goldsmith Lane Louisville, KY 40218 (502) 636-3207 Toll-Free (888) 636-8477 ***Masthead page AER Journal: Research and Practice in Visual Impairment and Blindness A quarterly journal in the field of education and rehabilitation of persons of all ages with low vision or blindness Volume 2 Number 2 Spring 2009 Editor-in-Chief Deborah Gold, Ph.D. CNIB Associate Editors Adele Crudden, Ph.D. Mississippi State University Amy R. McKenzie, Ed.D. Florida State University Rona Pogrund, Ph.D. Texas Tech University AER Journal Editorial Advisory Board Steven LaGrow, Ed.D. Massey University Sandra Lewis, Ed.D. Florida State University George Zimmerman, Ph.D. University of Pittsburgh AER Staff Jim Gandorf, CAE Executive Director Ginger Croce Director of Membership & Marketing AER Journal: Research and Practice in Visual Impairment and Blindness (ISSN 1945-5569) is published quarterly by the Association for Education and Rehabilitation of the Blind and Visually Impaired (AER), 1703 N. Beauregard Street, Suite 440, Alexandria, VA 22311-1744, (703) 671-4500, fax (703) 671-6391. AER, a 501(c)(3) tax-exempt organization, supports professionals who provide education and rehabilitation services to people with visual impairments, offering professional development opportunities, publications, and public advocacy. Publishing services provided by Allen Press, 810 E. 10th Street, Lawrence, KS 66044. All rights reserved. Reproduction in part or whole is prohibited. Copyright © 2009 Association for Education and Rehabilitation of the Blind and Visually Impaired. Printed in the U.S.A. Contact AER for copyright permission. Application to mail at periodicals postage rates is pending in Lawrence, KS. The annual print subscription rate is $99 for institutions in the U.S, $124 for institutions outside the U.S, including Canada and Mexico. Allow six weeks for shipment of first copy. Single copies are available at $30 in the U.S. and elsewhere at $40. All amounts are listed and payable in U.S. dollars. Contact aerj@allenpress.com for more subscription information. POSTMASTER: Send address changes to AER Journal, Association for Education and Rehabilitation of the Blind and Visually Impaired, 1703 N. Beauregard Street, Suite 440, Alexandria, VA 22311-1744. AER Journal does not accept responsibility for views expressed in articles, reviews, and other contributions that appear in its pages. AER Journal is a benefit of membership in AER. Call (877) 492-2708 or &703) 671-4500 for membership information and customer service inquiries. ***Advertisement AER Journal: Research and Practice in Visual Impairment and Blindness Call for Manuscripts Special AER Journal Theme Issue Do you work with children or adults who are deafblind- Do you conduct research involving persons with this dual disability- Consider submitting an article on your research or practice for our Special Theme Issue 2010: Issues in Services to People who are Deafblind Deafblindness creates challenges in communication, education and rehabilitation, as well as significant rewards. Professionals find there is only limited information in the research literature that applies to the work they do with people (of all ages) who are deafblind, or losing both hearing and vision simultaneously due to their age. This issue aims to fill that gap. Manuscript submission deadline: January 31, 2010. Publication date: August 11, 2010. Visit www.aerbvi.org for submission information. ***Table of Contents Special Issue: International Conference Proceedings, Part Two From the Editor 61 Deborah Gold Original Research 63 What Did that Alt Tag Say- Exploring Access to Visually-Based Web Course Explanations......63 Kim T Zebehazy Shifting Desktop Video Magnifier Monitors to Compensate for Central Scotomas......76 Kimberly A Schoessow Donald C Fletcher After One Year: Self-Reported Transition Skills of Teens with Visual Impairments......84 Sandra Lewis Julie A Bardin Tammy Jorgensen-Smith Practice Report 97 Decoding the Braille Riddle: Adapting a Direct Instruction Reading Program......97 Lynn Campbell Interview 103 A Wealth of Experience and Contribution: An Interview with Dr. Susan Spungin......104 Jane N Erin ***Advertisement got ce- Photo caption: AER Board Member Janie Blome, representing Instructional Services Divisions, does! Online Courses, On Demand! Featuring O&M, Itinerant Teaching, Adult Services, Low Vision, Info & Technology, Deafblind, Vocational Rehab, and more topics! Online Continuing Education Courses Featuring AER 2008 International Conference Presentations * Audio and power point presentations from the 2008 AER International Conference plus handouts that may be downloaded. * Easy to earn continuing education credit. * 30-minute (.5 CE credits), 60-minute (1 CE credit), 90-minute (1.5 CE credits), and 120-minute (2 CE credits) courses. * Only $25 per credit hour for members/$50 for non-members (USD). * For more information contact AER at 877-492-2708, 703-671-4500 or via e-mail at onlineCE@aerbvi.org. Click www.aerbvi.org to get started today! Association for Education and Rehabilitation of the Blind and Visually Impaired ***From the Editor Why Remember Louis Braille- In preparation for this commemorative issue of the AER Journal, I took a few moments to do a little data collection. I asked several braille users to comment (via e-mail) on what braille means to them (I simply asked them, “Can you send me a short paragraph about what braille means to you-”). In each case you will note the common theme. One 66-year-old woman states: Literacy and education are two basic rights that most people take for granted. Unfortunately, those of us who rely on braille are constantly having to desperately defend our right and need for braille literacy. I use braille in every aspect of daily living—jotting down phone numbers, labeling various cooking items, making a grocery list, labeling CDs, wine, household and garden products, medications for quick identification, and running off that daily “to do” list which I slip into my pocket as I dash out to do errands. Braille is also the medium I find most useful and comfortable for reading magazines from around the world, curling up with a good book in the evening, and reviewing braille documents related to my volunteer work. Braille helps me to be productive, independent and feel empowered and in touch. I asked a mother and her son to each try to answer the question. The mom wrote: Braille is of critical importance to children who are blind. My son can only compete in a sighted world if he is literate and literacy for a child who is blind is braille. One would imagine that today it would be easy for the education system to meet the needs of a child who is blind yet many parents still have had to fight for their child's education and for the right to learn braille. We must all work together to ensure the availability of qualified teachers, transcribers and braille materials. Watching my sons fingers dancing over a page of braille is a beautiful sight we never take for granted. Her eleven-year-old son's answer was simple and direct: Braille is very important to me especially when I am reading it because it almost puts pictures in my head about what is going on in the book (or whatever it is I am reading). I really enjoy using braille every day because it is easy to read and write with. And a grandmother in her eighties had this to say to me: Thanks for giving me an opportunity to say what braille means to me. I have been a braille user for over 60 years and it is essential in my daily activities. In my home I need braille for cooking, phone numbers and more. In my work as a rehabilitation teacher it enabled me to keep notes, records and other material necessary for my work. For the past few years I have been receiving my monthly bank statements in braille, also my Visa bill and my phone bill. This has been a real plus and has given me so much more independence and privacy. In recreation I love to sit down with friends and play a few games of cribbage or euchre or even have played bridge. At the present time I am teaching my grandson to play crib. (Something a grandmother loves to do) and oh yes [braille allowed me to read to my grandchildren through the] twin vision books I always took when visiting or baby sitting my grandchildren. I can't imagine a day without braille as a sighted person likely can't imagine a day without print. The legacy of Louis Braille is clearly evident in the worlds of education and rehabilitation of people who are blind or visually impaired. The system Louis Braille invented for reading and writing was an equivalent to Gutenberg's invention of the printing press for people with sight. As Euclid Herie (2008) has stated in his speech to the Seventh World Blind Union General Assembly in Geneva, Switzerland, August 2008: In the broader context, braille is a great deal more than a six-dot writing system gifted to the world by its architect, Louis Braille, nearly two centuries ago. Braille is literacy that has brought independence and empowerment to the blind of the world, through knowledge and lifelong learning. It has transformed lives, lifted millions out of poverty, enabled countless numbers of intelligent, hard-working people to perform responsible, meaningful work, contribute to their communities, provide for their families and enjoy rich, fulfilled lives. For more information about Louis Braille, or Braille 200 activities, go to the following websites: www.Braille200.ca; www.nbp.org; and www.afb.org. I invite you to read the articles in this issue with Louis Braille's gift to the world in mind. I think you will agree that Monsieur Braille would smile upon hearing that researchers are studying how to make print and the internet more accessible for people with low vision and blindness. He would also love to know that we are still working out the best way to teach students with multiple challenges how to read, using his code, and experiencing ever-increasing degrees of success. We offer this issue of the Journal as a small token of our profession's gratitude for the amazing contribution of the invention of the Braille Code, and in remembrance of a man whose incredible legacy lives on through his invention. As Terry Kelly, renowned singer-songwriter has written: “Merci Louis!” Until Next Time, Deborah Gold, PhD Editor-in-Chief (Captain) References Herie, E. (2008). Six dots that changed the world: In remembrance of Louis Braille (1809–2009). Speech to the Seventh World Blind Union General Assembly, Geneva, Switzerland, August. ***Web Course Explanations Original Research What Did that Alt Tag Say- Exploring Access to Visually-Based Web Course Explanations Kim T Zebehazy, PhD* Northern Illinois University, Dekalb, IL *Please address correspondence to kzebehazy@niu.edu Abstract This exploratory study tracked the performance and strategy use of two individuals who were blind and two individuals who were sighted when accessing two university online Web course lessons that contained visually based diagrams as part of the explanation. Each of the groups (blind and sighted) contained one novice and one “semi-expert” regarding the content in the lessons. Findings revealed no clear differences between performance of the individuals who were blind and those who were sighted. Performance was more closely related to individual factors, strategy use, and time spent on the lessons. Differences between the groups in accessing the material is discussed. Keywords: personnel preparation; Web course accessibility; novice and expert learners; alternate text; diagram accessibility Introduction Web-based distance education comes with the benefits of convenience and the potential to reach more students. Many teacher of the visually impaired certification programs have gone this route in order to reach a wider pool of future professionals (Cain & Merrill, 2001; Ferrell, Persichitte, Lowell, & Roberts, 2001; Rosenblum, 2001). In addition to making sure that the instructional approaches utilized in different distance education and hybrid programs promote optimal learning of all students, it is important to ensure that they are accessible to adaptive technology such as screen readers. Some online courses utilize multimedia techniques to create dynamic Web-based learning environments that facilitate understanding through visual and text-based instructional explanations. Access to instructional material through different modes is a desired component of the concept of Universal Design for Learning (CAST, 2008; Thompson, Johnstone, & Thurlow, 2002). For students without enough usable vision to benefit from visual representations via charts, diagrams, or videos, use of alternative text (alt tags) and audio description is a common adaptation. The use of alt tags, however, makes the multimodal presentation unimodal, that is, text only. Within the traditional campus-based classroom, instructional explanations can be modified by the instructor in the moment to address misunderstandings of visual information by the student. Students can also experience visual representations hands-on in the classroom through the use of objects, models, or tactile representations when appropriate. However, on the Web, some instructional explanations that incorporate visual representations to understand and practice concepts are more static. Since some content material lends itself well to visual representations to facilitate deeper understanding, this is an important area to investigate in order to ensure equal opportunity for students who are blind within the learning environment. For example, are predetermined nonvisual explanations that accompany visually based examples and representations an adequate substitution for the visual- In addition, is there a difference between individuals who already have some prior knowledge of the topic that incorporates the use of visually based explanations- Literature from various disciplines (e.g., Chi & Bassock, 1988; Leinhardt & Young, 1996; Price, 2007) suggests that learning techniques, engagement with materials, and levels of understanding can differ between novice and expert learners, which could mean that the manner in which information is presented may also be more or less effective for different levels of learners. The main purpose of this study was to gain practical insight into the effectiveness of explanations centered on visually based information such as diagrams. More specifically, the study sought to gather information regarding the following research questions: * How do students who are blind and sighted work through Web course explanations that contain visual components- * Are there any evident differences in performance between students who are blind and those who are sighted after lesson study- * Are there any evident differences in performance between novice and “semi-expert” learners- * What recommendations regarding Web course explanations emerged during this study- Participants Four individuals, two who were blind and two who were sighted, participated in this study. In each group (blind and sighted), one individual was a novice to the content being presented, and one individual was a semi-expert having had similar content in a face-to-face version of the course within the past year of participation. Table-1 summarizes the demographics of the participants. Table 1. Demographics of the Participants Participant Gender Vision Status Learner Status on Content Highest Degree Completed at Time of Study Other Female Congenitally blind Semi-expert BA in elementary and special education Braille and screen reader user Female Congenitally blind Novice High school and some college in psychology Braille and screen reader user Male Sighted Semi-expert BA in psychology Web course experience Female Sighted Novice MEd in special education Web course experience Methods Content Structure Each participant worked through two lessons within an online Introduction to the Eye and Low Vision course, which was part of the teacher of the visually impaired certification program at the university. The online course was delivered via Blackboard software. The two lessons were “Light and Optics” and the “Visual Pathway.” In the “Light and Optics” lesson, text explanations of the content were interspersed with visual diagrams (adapted from Jose, 1983) that illustrated how light bends through various lenses. Diagram-based practice problems were also included after each main concept for students to check their understanding of the material. Alt tags were attached to each diagram that gave a verbal description of the diagram for the screen reader users (see Figure-1 for an example). Fig. 1. Example of a diagram in the “Light and Optics” lesson with accompanying alt tag. Fig. 2. Percentage of correct responses on factual and application posttest questions. Similarly, the “Visual Pathway” lesson contained a text-based explanation that centered around one diagram of the visual pathway. Self-check questions requiring an understanding of the pathway were included within the lesson with the answer explanations and diagrams found below by scrolling. Alt tags were attached to each visual representation within the lesson. In addition to the traditional alt tag descriptions, the explanation of the chiasm of the visual pathway incorporated a braille cell description in an attempt to facilitate understanding of this concept for individuals who are blind (see Box 1). Both lessons also had jump links that could take the participant back to the top of the lesson from main sections. Box 1. Explanation of the chiasm using the braille cell (excerpt from a visual pathway breakdown list provided in the lesson). Data Collection Participants were asked to work through each lesson as if they were “a student trying to gain a good understanding of the material.” For each lesson, prior knowledge of the content was collected via 5-minute timed free-response questions: describe what you know about the visual pathway and describe what you know about light and optical lenses. Participants talked aloud their thoughts while moving through the lesson. The think-aloud procedure is one method to gain understanding about the cognitive processing of an individual during a task (Ericsson & Simon, 1994, as cited in Johnstone, Altman, & Thurlow, 2007). The researcher recorded, verbatim, what the participants were saying and also tracked the movement of each participant through the lesson, noting when the participant reread, backtracked, scrolled to another location, or conducted a second pass through the lesson. The total time spent on the lesson was also recorded. At the end of each lesson, participants answered the same 5-minute free-response question to gauge retention of the material, a procedure that was similar to that used by Mayer and Moreno (1998). In addition, they answered a series of factual and application questions based on the material they just studied. For “Light and Optics,” there were eight questions: four factual and four application. For the “Visual Pathway,” there were six questions: three factual and three application. Lesson order was counterbalanced between the participants in each group. Participants also answered opening and closing interview questions that solicited their comments, preferences, and feelings of preparedness. The researcher asked the following interview questions immediately after each lesson: What aspects of the lesson were most useful to you- What aspects of the lesson were confusing- What would have helped to increase your understanding- If you were the designer of the this Web course lesson, what changes would you make to help your own understanding; and do you have any other comments regarding the lesson study experience- Data Analysis Because of the small sample size, no inferential statistical analyses were conducted. However, the pre- and post-free-response questions were analyzed by documenting the number of specific and basic statements made about the topic area and calculating the percentage change in specific statements as well as the overall percentage change in accurate statements made (basic and specific). Because it was expected that semi-expert participants would be able to make more statements overall, use of percentage change was considered a better comparison. A basic statement gave information about the topic without using specific terminology, or jargon, so to speak, for the topic area. For example, “Light plays a significant role in the ability to see” was considered a basic statement, whereas “The plano lens is one without the curves” was considered a specific statement because the participant used the term “plano” accurately. The percentage correct of factual and application questions was also computed. Both of these measures were compared between groups to note any patterns. In addition, the transcripts of each participant's think-alouds were analyzed for patterns and emerging use of different strategies to engage with the material, and the patterns of moving through the material were graphically charted to compare differences. Interview questions were also reviewed for patterns between the groups and useful suggestions. Results Performance Table-2 illustrates the percentage change in the number of accurate pre- and post-free-response statements made for each topic area. Except in one instance, all participants made more statements after completing the lesson modules. As would be expected, the greatest change in the number of accurate statements made generally occurred for the novice participants, particularly in the area of light and optics. The novice participant who was blind showed a 350 percent increase in the number of overall statements made about light and optics and an 800 percent increase in the number of specific statements. The participant who was sighted showed a 400 percent increase in overall statements for this same lesson and a 200 percent increase in specific statements. Also as expected, while the novices showed the most change between the pre- and post-free-response questions in the number of responses made, the semi-experts still made the most statements overall and the most specific statements for both lessons at the pretest level and on the visual pathway lesson at the posttest level (see Table-2). Table 2. Number of Overall and Specific Statements Made and Percentage Change Between Pre- and Post-Free-Response Tests Novice Semi-expert Participant Who Is Blind Participant Who Is Sighted Participant Who Is Blind Participant Who Is Sighted Visual pathway Pretest overall 4 5 7 15 Posttest overall 6 5 10 18 Percent change 50 0 43 20 Pretest specific 4 2 6 14 Posttest specific 6 3 10 18 Percentage change 50 50 67 29 Light and optics Pretest overall 2 1 7 6 Posttest overall 9 5 8 11 Percentage change 350 400 14 83 Posttest specific 0 0 4 4 Posttest specific 8 2 7 10 Percentage change 800 200 75 150 Figure-2 illustrates the percentage of correct responses on the posttest for both modules combined. It also shows the breakdown of the percentage of factual versus application questions answered correctly. No clear pattern in performance between individuals who were sighted and those who were blind was evident, mainly because of the low performance across the board of the novice participant who was sighted. However, the two higher performers on the posttest (the novice participant who was blind and the semi-expert participant who was sighted) did spend more time with the material in each lesson than the other two participants—an average of 15-minutes more across the two lessons (see times in Figures-3 and 4). Fig. 3. Graphical representations of participant movement through the “Light and Optics” lesson. Fig. 4. Graphical representations of participant movement through the “Visual Pathway” lesson. When comparing just the semi-experts' performance, the individual who was sighted answered on average 46 percent more of the questions accurately. Both individuals who were blind answered about 7 percent more of the application questions correctly than the factual questions, whereas both individuals who were sighted answered more of the factual questions correctly than the application questions (7 percent more for the semi-expert and 14 percent more for the novice). An interesting and unexpected difference between the individuals who were blind was that the novice answered 14 percent more questions accurately than the semi-expert individual who was blind. Along with time spent on the task, this difference seems partially supported by the analysis of the think-aloud transcripts. Think-Aloud Analysis and Strategy Use While both individuals who were blind incorporated strategies to help understand and remember the material, the novice made more references to ways in which to work with the visual information that the other individual did not. For example, when first encountering a description of one of the diagrams in the light and optics chapter, she said, “Wow! If I were really taking this for a grade, I'd start playing with art objects right now.” She also referred to visualization strategies, stating, “I am trying to make a basic mental picture.” In addition, this participant asked to use a brailler in which she jotted down formulas and other words and symbols to support her understanding. While not actually using these strategies during the study, this participant also mentioned while working through the material other ways she might attack the diagrams. These suggestions included using a tactile diagram and brailling out the visual pathway words and connecting the words with lines to illustrate the pathway. The semi-expert who was blind did refer to the visual material in her think-aloud and during the interview, but her statements revolved more around how the visual information was a barrier. For example, she stated, “I think a lot of this would have been memory for me. I can only remember so much because I don't have the visual.” During the visual pathway lesson, she did incorporate a physical strategy of pointing to her own temporal and nasal areas, stating, “I think the pictures would have helped if someone described them to me and I physically did it.” All participants utilized self-questioning strategies, and this was evident in the transcriptions of the think-alouds by statements such as “Why would that bring it closer into your vision-” and “Okay, convex, what is convex-” The two participants who were sighted used this self-questioning technique when looking at the diagrams as well. All participants also repeated or summarized key aspects of the concepts while working through the material as a verbal way to practice the information, such as “Closer causes divergence,” “Okay, plus curves out,” and “So, basically it brings images closer.” The majority of the participants also employed backtracking strategies while doing self-checks. As presented in the next section, the way backtracking was executed differed between the participants who were sighted and those who were blind. Unique to the semi-experts was the use of reading to verify prior knowledge, making statements such as, “Yeah, that's right. I know that.” Similarly, however, both novices would make statements about what they did and did not know, self-monitoring, while reading through the material. This strategy was closely linked with self-questioning strategies. For example, the novice who was sighted made statements such as “I can label, yeah, not describe” and “I'm nervous. I'm thinking I do not have a true understanding of six and seven.” The novice who was blind made similar statements, such as “Right now it is the concept I find challenging, not the math” and “Hmm. I just realized I have no idea how we account for a minus.” Unique to the novices was the use of note taking while working through the material. Both participants who were blind utilized the screen reader to assist with understanding the material. The following list describes some of the screen reading strategies used: * Reading one line at a time instead of continuously * On a reread, filling in the end information before the screen reader read it to check for retention * Using the screen reader to check the spellings of new vocabulary * Reading word by word with the screen reader to understand the components of a formula Content Navigation Figures-3 and 4 graphically represent how the participants moved through the two lessons. Figure-3 shows movement through the “Light and Optics” lesson, and Figure-4 illustrates movement through the “Visual Pathway” lesson. The graphics divide the lesson into areas of text explanation, areas of visual diagrams or drawings, summary areas, and areas that contained answer explanations to the practice problems. An X on the graphic represents the first read in those sections by the participant. An R represents rereading the section at which the participant was currently located, B represents backtracking to a previous section to reread or check for information, and S represents scrolling through an area to find something but not necessarily rereading a section. In addition, one participant did a second pass through practically the whole lesson. This is represented by the number 2. As seen in these graphical representations, the two participants who were blind on both lessons tended to move more linearly through them. When backtracking occurred, it was usually only one section back. Also related, rereading the same section was more frequent with the participants who were blind. This occurred in almost all the section types, including the diagram areas where rereading of the alt tags would have occurred. The novice who was sighted utilized the diagrams frequently, showing a backtracking pattern to the diagrams throughout both lessons. The semi-expert who was sighted backtracked to diagrams less frequently but did do a second pass of the material on both lessons. This was unique to this individual, although each of the participants who were blind did do a second pass once to one section of a lesson. Interviews When asked what were the most useful parts of the lessons, both individuals who were sighted indicated that the diagrams were the most useful. The two individuals who were blind indicated that they liked the description of the chiasm utilizing the braille cell as a reference point. They similarly indicated that “I could actually visualize that. It helped clarify the visual fields for me.” In addition to the chiasm explanation, the two participants who were blind also mentioned other particular explanations that seemed to work well for them. One participant mentioned liking the text explanations that directly indicated the differences between key terminologies. The novice participant mentioned the explanations on the diagrams and alt tags. She stated, “I was surprised the explanation was good enough to get something out of it with all text, no tactual.” When asked about what was confusing in the lessons, all participants indicated some aspect of the content, such as the formulas, too much terminology to remember, or how a particular concept was explained. In addition, the two participants who were blind indicated specific aspects that were confusing because of the lack of a visual and/or because of the physical placement of the information within the lessons. For example, the semi-expert who was blind stated, “Formulas (I'm not a math person)—it was mostly visual; I'd need a reference point—be looking right at it.” The novice who was blind stated, “Worst one was equations bunched together in the text. They should appear on their own line” and “The example questions were a pain because they were separated in space between the question and the answer.” Interestingly, when asked what would have helped increase their understanding, all but the novice who was sighted referred to the need for a “visual.” The semi-expert who was sighted noted two occasions where an additional diagram would have been useful, particularly of the optical lenses. Both participants who were blind also mentioned the lenses. The semi-expert stated that it would have been helpful to “have actual lenses, physical ones I could touch, and someone actually explaining it to me and walking through the examples.” The novice mentioned having “a tactile display of basic lens shapes—send in the mail.” In addition, both of the novices noted the need for additional examples and explanations to really grasp the material, indicating that it depended on the level at which the person came into the lesson, but for them, a supplemental text or additional explanation would be useful. The suggestion for tactile displays also emerged when the participants were asked what they would do differently if they were the designer of the Web lesson. Additionally, the novice who was blind mentioned that a summary list of key terms and definitions at the end of the lesson would be of benefit. The novice who was sighted mentioned her need to hear the lesson and/or see an expert modeling the examples. She mentioned use of the virtual classroom chat feature in Blackboard or use of videos. Finally, as part of the opening interview before doing any lesson study, participants were asked to rate on a scale of 1 to 5 the usefulness of different instructional formats to their personal learning. A rating of 1 meant “not useful at all,” and 5 meant “very useful.” For graphics, the participants who were blind (rating them a 1) were on the opposite side of the spectrum from the participants who were sighted (both rating them a 5). There were some common instructional formats that all participants rated as either a 4 or a 5: text, auditory presentations, examples, practice opportunities, discussion, and individual projects. All but one participant indicated the following instructional formats as a 4 or 5: observations, case studies, and written papers. Ratings on the remaining choices were more mixed: video presentations, PowerPoint presentations, group projects, reading guides, and tests and quizzes. It should be noted that one participant rated tests and quizzes lower because she did not view it as an instructional method. Discussion Summary Overall, all participants showed an increase in content knowledge after study of the lessons. There was no clear distinction in performance between the participants who were blind and the participants who were sighted. The amount of time spent with the lesson and how actively participants utilized strategies for learning the material was more closely linked with performance. However, both participants who were blind answered at best 70 percent of the factual and application questions correctly. Given the comments made about the need for tactile displays, clearer explanations for some of the concepts, and a need for someone to walk through the examples, performance of the participants who were blind may have been higher with the incorporation of some of their suggestions for better access. The manner in which the participants who were blind and those who were sighted moved through the material differed. The participants who were blind, in general, moved through the material in a more linear fashion and backtracked only to the prior section rather than moving back to sections toward the beginning of the lesson. Despite the presence of jump links (which should be noted were not explicitly pointed out to the participants), large movements back and forth between sections were not observed. The participants who were sighted displayed more of this back-and-forth movement pattern, particularly the novice. Some differences between novice and semi-expert participants also emerged. Both novices felt the need for more explanations and examples, recognizing, however, that as a real student in the course, they could spend more time with the material. The semi-experts were able to make more statements about the material overall on both the pre- and the post-free-response tests. There was also a subtle difference in the strategies used, with the semi-experts reading to verify prior knowledge—something novices would not be able to do. Study Limitations Because of a small sample size, generalizations of these results cannot be made to other individuals who may be accessing a Web course. In addition, the study looked at a particular method for delivering instruction: text-based explanations with accompanying graphics made accessible through the use of alt tags or alternate explanations. Results might not be applicable to other types of instructional formats used in Web courses. Finally, participants were a convenience sample and were not actually in the Web course; therefore, motivation to do well was not necessarily present. This may have affected the performance outcome of some of the participants. Implications Despite the limitations, however, this study highlights some aspects of Web course explanations that can support good design and access as well as strategies that individuals may utilize while trying to engage with a fairly static learning environment. The following list summarizes some considerations: * For examples and practice problems, all pertinent information should be in close proximity. * Consider when alternate explanations can incorporate a method to help the student who is blind mentally create an image (e.g. use of the braille cell or other common reference point). * Consider the feasibility of offering tactile graphics as an option for diagrams that are pertinent to conceptual understanding. * Be consistent in the format of explanations. Graphics coming before an explanation in one example and after in another was confusing to the screen reader users. * Consider providing a list of key terms and concepts that students who are sighted know are important because of the use of bolding. Also consider explicit explanations of the differences between key terminologies. In addition to the design considerations, the types of strategies used by students to engage with the materials are also important. For students who are blind, having a repertoire of strategies for “attacking” visually based information can be beneficial to increasing understanding of the concepts. For students who are used to being guided through visual information firsthand, a switch in strategies may be necessary for Web course study. References Cain, H.M., & Merrill, Z. (2001). Distance education for master's students with visual impairments: Technology and support.Journal of Visual Impairment and Blindness, 95, 72-575. Center for Applied Speicial Technology (CAST). (2008). Universal design for learning guidelines version 1.0 Wakefield, MA: CAST Chi, M.T.H., & Bassock, M. (1988). Learning from examples via self-explanations (Technical Report 11) Pittsburgh, PA: Learning Research and Development Center Ericsson, K.A., & Simon, H.A. (1994). Protocol analysis: Verbal reports as data (Rev. ed.) Cambridge, MA: MIT Press Ferrell, K.A., Persichitte, K.A., Lowell, N., & Roberts, S. (2001). The evolution of a distance delivery system that supports content, students and pedagogy.Journal of Visual Impairment and Blindness, 95, 597-608. Johnstone, C., Liu, K., Altman, J., & Thurlow, M. (2007). Student think aloud reflections on comprehensible and readable assessment items: Perspectives on what does and does not make an item readable (Technical Report 48) Minneapolis, MN: University of Minnesota, National Center on Educational Outcomes Jose, R.T. (1983). Understanding low vision New York, NY: AFB Press Leinhardt, G., & Young, K.M. (1996). Two texts, three readers: Distance and expertise in reading history.Cognition and Instruction, 14, 441-486. Mayer, R.E., & Moreno, R. (1998). A split-attention effect in multimedia learning: Evidence for dual processing systems in working memory.Journal of Educational Psychology, 90, 312-320. Price, L. (2007). Lecturers' vs. students' perceptions of the accessibility of instructional materials.Instructional Science: An International Journal of Learning Sciences, 35, 317-341. Rosenblum, L.P. (2001). One professor's perspective: Preparing teachers of students with visual impairments at a distance.Journal of Visual Impairment and Blindness, 95, 558-562. Thompson, S., Johnstone, C.J., & Thurlow, M.L. (2002). Universal design applied to large scale assessments (Synthesis Report 44) Minneapolis, MN: University of Minnesota, National Center on Educational Outcomes ***Shifting Monitors for Scotomas Original Research Shifting Desktop Video Magnifier Monitors to Compensate for Central Scotomas Kimberly A Schoessow, OTD* Smith-Kettlewell Eye Research Institute, San Francisco, CA Washington University in St. Louis, St. Louis, MO Donald C Fletcher, MD Smith-Kettlewell Eye Research Institute, San Francisco, CA California Pacific Medical Center, San Francisco, CA *Please address correspondence to kimberly_schoessow@meei.harvard.edu Abstract Flexible arms that allow shifting of desktop video magnifier monitors may compensate for visual field loss. Patients with central field loss can shift the monitor away from their scotomas, potentially improving their ability to use eccentric viewing. This study examined whether patients with field loss preferred a video magnifier monitor shifted off center into their area of best vision. Forty patients were demonstrated the flexible arm on the Merlin LCD and tried the monitor in various positions. Participants' choice of monitor placement was compared with foveal function and scotoma location. Seven participants shifted the monitor off center. Six of them shifted it directly away from the location of their scotoma. All seven lacked functioning foveas and had worse visual function than those who left it centered. Limitations included a small sample and potential bias during data collection. Nonetheless, this pilot study presents data suggesting that shifting the desktop video magnifier monitor into the better field may improve functional vision for patients who have significant interference from scotomas. Keywords: video magnifier; closed-circuit television; scotoma; age-related macular degeneration Introduction Desktop video magnifiers, also referred to as closed-circuit televisions, are invaluable tools for allowing people with low vision to participate in sustained reading and writing tasks. They allow people to read for pleasure, manage finances, access safety precautions on medication and food labels, and view pictures of loved ones. Compared with other optical aids such as handheld magnifiers and close-focus glasses, video magnifiers allow greater magnification, a wider field of view, and the ability to manipulate contrast (Wolffsohn & Peterson, 2003). Desktop video magnifiers generally allow people with low vision to perform longer sustained reading (Watson, De L'aune, Long, Maino, & Stelmack, 1997) and writing that would be difficult or impossible with alternative types of optical devices. With sufficient training (Copolillo & Teitelman, 2005; Goodrich, Kirby, Oros, Waystaff, McDevitt, Hazan, & Peters, 2004a; Scanlan & Cuddeford, 2004), video magnifiers can be used for an unlimited number of both basic and instrumental activities of daily living. Although technological advances are continually updating video magnifiers, the general stand-mounted format includes a camera and light source projected down onto a flat table that can either move for navigating text when reading or be locked into place for writing (Beaver & Mann, 1995). The cameras on most current video magnifiers automatically self-focus on the object or reading material placed on the table. The camera relays its image to a monitor, and the image can be modified to create optimal color, polarity, contrast, and brightness levels. Many current desktop video magnifiers now feature flat-screen monitors with liquid crystal displays (LCD; Wolffsohn & Peterson, 2003). One model, the Merlin LCD (Enhanced Vision Systems, Huntington Beach, CA), has a flexible arm that allows the user to shift the monitor up to 8-inches horizontally and 5-inches vertically. Features of most current video magnifiers compensate for impairment in visual acuity and contrast sensitivity. Depending on the model, magnification can be adjusted up to 60× to assist users with decreased visual acuity. Polarity, color, and brightness can be individualized to make material more visible to users with decreased contrast sensitivity. These adjustments, common to video magnifiers, improve efficiency of reading and performance of activities of daily living (Goodrich, Kirby, Wagstaff, Oros, & McDevitt, 2004b). However, visual functions include more than visual acuity and contrast sensitivity: Field of view completes the visual triad (Fletcher & Schuchard, 2006). Loss of peripheral visual field can lead to impairments in mobility and scanning the environment (Brennan, Horowitz, Reinhardt, Cimarolli, Benn, & Leonard, 2001; Ramrattan, Wolfs, Panda-Jones, Jonas, Bakker, Pols, Hofman, & de Jong, 2001). Loss of vision within the central 15 degrees of the field of view can lead to drastic reductions in reading ability. Individuals with central field loss, especially with a loss of foveal function, read slower and make more errors than do individuals with intact central fields (Cummings, Whittaker, Watson, & Budd, 1985; Fletcher & Schuchard, 2006; Fletcher, Schuchard, & Watson, 1999). Impairment in reading ability not only causes loss of enjoyment in leisurely reading (Ramrattan et al., 2001) but can also lead to safety hazards, such as misreading dosage instructions on medication labels, expiration dates on food, and amounts due on bills. Central visual field loss is especially prevalent in eye conditions affecting the macula, such as age-related macular degeneration. In a study involving 825 patients with maculopathy, optic neuropathy, and retinopathy, 82.5 percent of eyes had a dense central scotoma (Fletcher & Schuchard, 1997). These patients with central field loss can learn to adapt to the scotoma by using both magnification and eccentric viewing (Crossland, Culham, Kabanarou, & Rubin, 2005). Magnification, especially through the use of a video magnifier, is generally helpful to individuals with central field loss, as it allows them to compensate for the decreased acuity naturally found in the more eccentric retinal areas. However, video magnifiers have historically addressed only two parts of the visual triad: acuity and contrast sensitivity. New technological developments are making it possible for video magnifiers to potentially address the third part of the triad: visual field. Desktop video magnifiers with a flexible arm attached to the monitor can be positioned in the patient's best field. Shifting the monitor could potentially compensate for peripheral field impairments resulting from hemianopsia or visual inattention and could assist with eccentric viewing for people with central field loss. This technology could be especially useful as an environmental compensation for patients who have difficulty perfecting fixation with a preferred retinal locus (PRL) due to complicated scotoma patterns, cognitive deficits, or a general lack of understanding of eccentric viewing concepts (Al-Karmi & Markowitz, 2006). This small pilot study is the first step in determining whether video magnifiers have the potential to address not only visual acuity and contrast sensitivity but also visual field. The study was performed to determine whether there are patients with central visual field loss who prefer that the desktop video magnifier monitor be positioned away from their scotoma in their best visual field. Methods During the study period, all consecutive patients in a low-vision clinic at a large urban hospital received usual care and were candidates for the study. Inclusion criteria consisted of the potential to benefit from desktop video magnifier use, as determined by the low-vision ophthalmologist's clinical impression based on magnification needs, visual goals, and success using other optical aids, such as magnifiers and close-focus glasses. Patients were not excluded on the basis of age, gender, visual function, or eye condition. Diagnosis was not an exclusion criteria because even eye conditions such as glaucoma and retinitis pigmentosa that affect peripheral fields first are capable of affecting central vision over time. Forty patients met the inclusion criteria for the study. As part of the routine low-vision rehabilitation evaluation, monocular best corrected visual acuity was measured using the Early Treatment of Diabetic Retinopathy Study chart (Ferris, Kassoff, Bresnick, & Bailey, 1982). The Mars Letter Contrast Sensitivity Test (Arditi, 2005; Dougherty, Flom, & Bullimore, 2005) was used binocularly to measure contrast sensitivity. It consists of 48 letters, each differing in contrast by 0.04 log units. Maximum reading speed and minimum print size were measured using the MNread (Legge, Ross, Luebker, & LaMay, 1989). Maximum reading speed was the shortest time in which the participant read any one of the MNread phrases, and minimum print size was the smallest print that the participant was able to read using his or her own reading glasses. Participants' central visual fields were evaluated by the ophthalmologist using a scanning laser ophthalmoscope (SLO; SLO-101, Rodenstock, Dusseldorf, Germany) with a “smart microperimetry” (MacKeben & Gofen, 2007) program with gaze-contingent display. During the SLO examination, participants were instructed to fixate a central cross and press a button when they saw a target presented. Stimuli were 0.3-degree-size targets with a 50,000-troland luminance, presented for 200-ms each. Target locations were selected by the ophthalmologist and scattered throughout the central visual field. Based on locations where the participants did or did not see the stimuli, the ophthalmologist mapped the areas of seeing and nonseeing retina. The “smart microperimetry” program enabled the ophthalmologist to determine whether each participant fixated at the fovea and thus had a functioning fovea and also which fields—superior, inferior, right, and/or left—had scotoma interference within 2 degrees of fixation. During the low-vision rehabilitation evaluation, the ophthalmologist also demonstrated the features and uses of the Merlin LCD, including the ability to shift the screen horizontally and vertically. The Merlin was chosen because at the time of data collection, it was the only desktop video magnifier on the market with a horizontally adjustable monitor. The ophthalmologist first placed a newspaper article under the camera and demonstrated basic features such as size, polarity, and color. He then told the participant that the screen could be moved up, down, and side to side. Participants were given the opportunity to practice using the Merlin and were instructed to try the monitor placed up, down, right, and left. Participants were allowed to practice until they found a preferred size, color, polarity, and monitor location to best read a line of newsprint. The ophthalmologist observed the practice time to ensure that participants did indeed experiment with the monitor at various locations. Participants were then asked a forced-choice question about whether they preferred the screen centered, up, down, right, or left. The research team compared participants' preference for monitor location with the presence of a functioning fovea and the location of any central scotomas. Data analysis included descriptive statistics and comparisons of means. Two-tailed Student t tests were conducted to evaluate group differences between participants who preferred the monitor centered versus shifted. Nominal variables were analyzed with chi-square tests. Statistical significance was considered at p < .05. Results During the study period, 40 patients were candidates for desktop video magnifier use. Thirty-four of the participants had a visual condition that commonly affects the central visual field: age-related macular degeneration, juvenile macular degeneration, or diabetic retinopathy. Nine participants had a visual condition that does not primarily affect the central visual field; nonetheless, six of the nine (66.7 percent) did have some central visual field loss. Instances of diagnoses do not equal the total number of participants because some participants have more than one eye condition. None of the participants had previously received eccentric viewing training. Five had previously used a desktop video magnifier, all of whom chose to keep the monitor centered. Table-1 describes the sample's demographics and visual function characteristics. Of the study's 40 participants, seven preferred the desktop video magnifier monitor at an off-center location. Participants who preferred the monitor shifted did not differ significantly in age, gender, or visual acuity from participants who preferred the monitor centered. However, participants who preferred the monitor off center had significantly decreased contrast sensitivity (p < .05), required a larger minimum print size (p < .001), and had a slower maximum reading rate (p < .001). While participants who preferred the monitor centered had a variety of diagnoses, all participants who preferred the monitor off center were diagnosed solely with age-related macular degeneration. All the participants who shifted the monitor lacked a functioning fovea (p < .001). Table 1. Demographics and Visual Functions Participants Leaving Monitor Centered (N = 33) Participants Shifting Monitor Off Center (N = 7) p n % N % Men 13 39.4 4 57.1 Women 20 60.6 3 42.9 Visual diagnosisa Age-related macular degeneration 19 57.6 7 100 Albinism 1 3.0 — — Diabetic retinopathy 7 21.2 — — Epiretinal membrane 2 6.1 — — Juvenile macular degeneration 2 6.1 — — Primary open-angle glaucoma 3 9.1 — — Retinal detachment 2 6.1 — — Retinitis pigmentosa 2 6.1 — — Functioning fovea 25 75.8 — — .000 Eccentric preferred retinal locus 8 24.2 7 100 .000 Location of scotomasb Superior 18 54.5 6 85.7 Inferior 15 45.5 1 14.3 Right 20 60.6 4 57.1 Left 12 36.4 2 28.6 Ring 9 27.3 1 14.3 Previously owned desktop video magnifier 5 15.2 — — .271 Mean Range Mean Range Age 74 39–102 82 69–94 .061 OD visual acuity 20/548 20/40–20/4000 20/813 20/500–20/1600 .236 OS visual acuity 20/616 20/40–20/4000 20/647 20/401–20/1000 .883 OU contrast sensitivity (log CS) 1.08 0.56–1.44 0.56 0–0.96 .035 MNread minimum size (M) 2.1 0.4–8.0 7.6 5.0–10.0 .000 MNread maximum rate (wpm) 80.0 14.7–222.2 9.6 2.5–57.1 .000 aThe sum of visual diagnoses exceeds 100 percent because of some participants having multiple visual conditions. bThe sum of scotoma locations exceeds 100 percent because of some participants having scotomas bordering multiple sides of the PRL. Of the seven participants who chose to shift the monitor, four preferred it shifted left, two preferred it to the right, and one preferred it shifted inferiorly. Six of the seven participants shifted the monitor directly away from the direction of their scotoma: Those who shifted it left had a right-sided scotoma, those who moved it right had a left-sided scotoma, and the participant who shifted it inferiorly had a superior scotoma. The seventh participant had a ring scotoma without a functioning fovea and shifted the monitor left toward an eccentric PRL. Discussion Several limitations exist in the present study. The low-vision clinic that provided participants has a single low-vision rehabilitation ophthalmologist; thus, the physician who performed microperimetry and determined the location of scotomas also evaluated the participants' use of the video magnifier. Although the ophthalmologist attempted objectivity in data collection, there is a higher margin of error than had a masked researcher evaluated monitor location preference. Additionally, because of the nature of the exploratory study, a relatively small sample size was used. Further work in this area would require larger samples. The content of this study relates to the theoretical concept supporting image relocation with prisms. Prisms are used for both field displacement and expansion with a variety of diagnoses, including stroke and retinitis pigmentosa (Markowitz, 2006). Prisms have been used with patients with maculopathy, with claims of improving scores on near and distance visual acuity by shifting the visual image onto a healthy area of the retina (Al-Karmi & Markowitz, 2006; Rosenberg, Faye, Fischer, & Budick, 1989). Some studies suggest that image relocation with the use of prisms decreases the amount of magnification necessary to perform near task activities (Al-Karmi & Markowitz, 2006). However, image relocation using prisms has not been shown to be effective. One study's results did not reach significance at the p < .05 level (Rosenberg et al., 1989), and elsewhere prism relocation has been shown to be no more effective than conventional spectacles (Smith, Dickinson, Cacho, Reeves, & Harper, 2005). Shifting the monitor of a desktop video magnifier may prove more effective than using prisms for image relocation. Like image relocation, shifting the monitor can project the visual image onto a healthier, nonscotomatous area of the retina. However, it may be more functional for patients than prisms because it shifts only the desired image rather than the entire visual environment, thus eliminating many of the motor coordination difficulties inherent in prismatic image relocation. It also may be more successful: Since patients are aware that the image has shifted, they may be better able to use the visual information and thus would not encounter the difficulty found with prisms when patients refixate behind the prism (Leat, Campbell, & Woo, 2001). Moving the monitor into the best retinal field thus has the potential to improve the patient's perception of the image projected on the video magnifier. The participants in the current study who preferred the monitor off center had significantly worse visual functions than those who chose a central location. They read slower, required larger print to read, and needed better contrast in print. For these patients, shifting the monitor out of their nonfunctioning fovea and into their better field may have improved their visual perception of the reading material. It may also have produced nonvisual benefits, such as an improved ergonomic position with less compensatory head movements that are common to low-vision patients who have not yet received eccentric viewing training. This pilot study provides preliminary data suggesting that video magnifiers may be used to compensate not only for decreased visual acuity and contrast sensitivity but also for central visual field loss. Although the percentage of participants choosing to shift the monitor—17.5 percent—was not statistically significant, it is clinically significant in that if the study results remain consistent in further studies, one out of every five or six low-vision patients may benefit from a desktop video magnifier with a flexible monitor arm. Further work should be performed to determined whether patients who originally choose to shift the monitor maintain the same eccentric position over time. If they do, low-vision professionals should teach the option of an off-center position as part of their standard desktop video magnifier training for patients. Alternatively, it is possible that as patients' eccentric viewing skills develop and they become more comfortable using their PRL, they may move the monitor back to center. Even if there was found to be a tendency to return the screen to center over time, a flexible monitor could serve as the impetus to jump-start patients' use of a desktop video magnifier before their eccentric viewing skills are fully developed. Patients who would ordinarily decline the video magnifier outright because scotoma interference makes the machine appear difficult and ineffective may instead be persuaded to attempt the video magnifier with the monitor shifted into their better field. This would allow earlier video magnifier use, providing more time during the rehabilitation process for training using the device. Additional time spent training, up to approximately 3 to 5-hours per device, increases the likelihood that patients will use the device effectively and frequently (Copolillo & Teitelman, 2005; Goodrich et al., 2004a; Scanlan & Cuddeford, 2004). Future work should also explore whether preference for monitor location correlates with performance on visual tasks. Research is continually showing that subjective patient report must be corroborated with objective measurement of patient performance (Eekhof, De Bock, Schaapveld, & Springer, 2000; Goverover et al., 2005; Rovner, Casten, Hegel, & Tasman, 2006; Skeel, Nagra, VanVoorst, & Olson, 2003). Patients with a preference for off-center monitor placement could be evaluated performing various visual activities, such as reading a newspaper, writing a check, and identifying medication dosage directions. A flexible desktop video magnifier monitor would be beneficial if patients' performance of visual tasks improves when the monitor is shifted away from the scotoma. Thus, despite this exploratory study's limitations, it provides an indication for further exploration into potential uses of new video magnifier technology to compensate for central visual field loss. References Al-Karmi, R., & Markowitz, S.N. (2006). Image relocation with prisms in patients with age-related macular degeneration.Canadian Journal of Ophthalmology, 41, 313-318. Arditi, A. (2005). Improving the design of the letter contrast sensitivity test.Investigative Ophthalmology and Visual Science, 46, 2225-2229. Beaver, K.A., & Mann, W.C. (1995). Overview of technology for low vision.American Journal of Occupational Therapy, 49, 913-921. Brennan, M., Horowitz, A., Reinhardt, J.P., Cimarolli, V., Benn, D.T., & Leonard, R. (2001). In their own words: Strategies developed by visually impaired elders to cope with vision loss.Journal of Gerontological Social Work, 35, 107-129. Copolillo, A., & Teitelman, J.L. (2005). Acquisition and integration of low vision assistive devices: Understanding the decision-making process of older adults with low vision.American Journal of Occupational Therapy, 59, 305-313. Crossland, M.D., Culham, L.E., Kabanarou, S.A., & Rubin, G.S. (2005). Preferred retinal locus development in patients with macular disease.Ophthalmology, 112, 1579-1585. Cummings, R.W., Whittaker, S.G., Watson, G.R., & Budd, J.M. (1985). Scanning characters and reading with a central scotoma.American Journal of Optometry and Physiological Optics, 62, 833-843. Dougherty, B.E., Flom, R.E., & Bullimore, M.A. (2005). An evaluation of the Mars Letter Contrast Sensitivity Test.Optometry and Vision Science, 82, 970-975. Eekhof, J.A.H., De Bock, G.H., Schaapveld, K., & Springer, M.P. (2000). Screening for hearing and visual loss among elderly with questionnaires and tests: Which method is the most convincing for action-Scandinavian Journal of Primary Health Care, 18, 203-207. Ferris, F.L. III Kassoff, A., Bresnick, G.H., & Bailey, I. (1982). New visual acuity charts for clinical research.American Journal of Ophthalmology, 94, 91-96. Fletcher, D.C., & Schuchard, R.A. (1997). Preferred retinal loci relationship to macular scotomas in a low-vision population.Ophthalmology, 104, 632-638. Fletcher, D.C., & Schuchard, R.A. (2006). Visual function in patients with choroidal neovascularization resulting from age-related macular degeneration: The importance of looking beyond visual acuity.Optometry and Vision Science, 83, 178-189. Fletcher, D.C., Schuchard, R.A., & Watson, G. (1999). Relative locations of macular scotomas near the PRL: Effect on low vision reading.Journal of Rehabilitation Research and Development, 36, 356-364. Goodrich, G.L., Kirby, J., Oros, T., Wagstaff, P., McDevitt, B., Hazan, J., & Peters, L.J. (2004a). Goldilocks and the three training models: A comparison of three models of low vision reading training on reading efficiency.Visual Impairment Research, 6, 135-152. Goodrich, G.L., Kirby, J., Wagstaff, P., Oros, T., & McDevitt, B. (2004b). A comparative study of reading performance with a head-mounted laser display and conventional low vision devices.Journal of Visual Impairment and Blindness, 98, 148-159. Goverover, Y., Kalmar, J., Gaudino-Goering, E., Shawaryn, M., Moore, N.B., & Halper, J. (2005). The relation between subjective and objective measures of everyday life activities in persons with multiple sclerosis.Archives of Physical Medicine and Rehabilitation, 86, 2303-2308. Leat, S.J., Campbell, M.C.W., & Woo, G.C. (2001). Changes in fixation in the presence of prism monitored with a confocal scanning laser ophthalmoscope.Clinical and Experimental Optometry, 84, 132-138. Legge, G.E., Ross, J.A., Luebker, A., & LaMay, J.M. (1989). Psychophysics of reading. VIII. The Minnesota low-vision reading test.Optometry and Vision Science, 66, 843-853. MacKeben, M., & Gofen, A. (2007). Gaze-contingent display for retinal function testing by scanning laser ophthalmoscope.Journal of the Optical Society of America, 24, 1402-1410. Markowitz, S.N. (2006). Principles of modern low vision rehabilitation.Canadian Journal of Ophthalmology, 41, 289-312. Ramrattan, R.S., Wolfs, R.C.W., Panda-Jones, S., Jonas, J.B., Bakker, D., & Pols, H.A. (2001). Prevalence and causes of visual field loss in the elderly and associations with impairment in daily functioning: The Rotterdam study.Archives of Ophthalmology, 119, 1788-1794. Rosenberg, R., Faye, E., Fischer, M., & Budick, D. (1989). Role of prism relocation in improving visual performance of patients with macular degeneration.Optometry and Vision Science, 66, 747-750. Rovner, B.W., Casten, R.J., Hegel, M.T., & Tasman, W.S. (2006). Minimal depression and vision function in age-related macular degeneration.Ophthalmology, 113, 1743-1747. Scanlan, J.M., & Cuddeford, J.E. (2004). Low vision rehabilitation: A comparison of traditional and extended teaching programs.Journal of Visual Impairment and Blindness, 98, 601-611. Skeel, R.L., Nagra, A., VanVoorst, W., & Olson, E. (2003). The relationship between performance-based visual acuity screening, self-reported visual acuity, and neuropsychological performance.The Clinical Neuropsychologist, 17, 129-136. Smith, H.J., Dickinson, C.M., Cacho, I., Reeves, B.C., & Harper, R.A. (2005). A randomized controlled trial to determine the effectiveness of prism spectacles for patients with age-related macular degeneration.Archives of Ophthalmology, 123, 1042-1050. Watson, G.R., De L'aune, W., Long, S., Maino, J., & Stelmack, J. (1997). Veterans' use of low vision devices for reading.Optometry and Vision Science, 74, 260-265. Wolffsohn, J.S., & Peterson, R.C. (2003). A review of current knowledge on Electronic Vision Enhancement Systems for the visually impaired.Ophthalmic and Physiological Optics, 23, 35-42. ***Self-Reported Transition Skills Original Research After One Year: Self-Reported Transition Skills of Teens with Visual Impairments Sandra Lewis, EdD* Florida State University, Tallahassee, FL Julie A Bardin, PhD North Carolina Central University, Durham, NC Tammy Jorgensen-Smith, PhD University of South Florida, Tampa, FL *Please address correspondence to slewis@fsu.edu Abstract Students' changed perceptions of their generalized functioning in areas related to successful transition to adult life were used as one measure of the success of a summer transition program. During the year between the two administrations of the Transition Competencies Checklist, participants perceived that their overall competency in key skills associated with successful transition had improved. Although due to the study's design, no direct association between these changes in perception and program involvement can be identified, increases occurred in the very areas that were systematically targeted, including (a) understanding work based on real-life experiences, (b) self-advocacy, (c) knowledge of career options, and (d) mastery of career counseling areas. One year later, students also perceived that they would be less dependent as adults. No significant differences were found between the ratings of the overall transition competencies based on previous paid work experiences, gender, or reading mode. The results provide additional evidence that targeting specific transition skills known to present challenges to students with visual impairments, as through this summer transition program, can be of value. Keywords: transition; students with visual impairment; vocational training; career education The successful transition of students with disabilities to postschool activities requires that students possess a complex array of abilities and aptitudes. Wehman (2001) described seven areas in which youth with disabilities face transitions: employment, living arrangements, transportation, financial responsibility, friendships, sexuality and self-esteem, and having fun. In order to have the skills to negotiate these transitions, most of these students may need to be supported with academic training, as well as training in the areas of vocational, social, and personal development (Kohler, 1998). In their analysis of the research of the practices that support student transition, Hughes and Kim (1998) concluded that a model of student support must focus on “self-determination, personal satisfaction, supportive environments, social interaction, independence, social acceptance and employment” (pp. 379–380). It is recommended that programs designed to improve the school-to-work outcomes of students with disabilities be multifaceted and promote individual choice, develop school and community partnerships, and incorporate academic skills (Stuart & Smith, 2002). Given that successful transition requires complex skills involving development within and across multiple domains (Miller, Lombard, & Corbey, 2007), it is a challenge for educators to measure the effectiveness of transition programs. The ultimate outcomes, of course, are that (a) students integrate and generalize desired transition attitudes, knowledge, and skills to the natural context for appropriate use and (b) effortlessly demonstrate skills when needed. This sophisticated summative outcome, however, is generally not realized for most school-age students during or even at the end of their participation in any one program. Not surprisingly, most evaluations of transition activities focus on short-term, easily measurable gains of student skills in discrete areas, such as self-determination (Agran, Cavin, & Wehmeyer, 2006; Arndt, Konrad, & Test, 2006; Carter, Lane, Pierson, & Glaeser, 2006; Jones, 2006), work skills (Bullis & Yovanoff, 2006; Ozawa & Yeo, 2006), and independent living (Fisher & Barkley, 2006). Descriptions of the efficacy of transition programs typically include anecdotal information of student satisfaction and relative improvement in skills, as Sabbatino and Macrine (2007) recently provided when describing the Start on Success model transition program. Few programs attempt to measure their overall effectiveness by evaluating changes in students' transition skills over a longer period time, a metric that, though imperfect, might suggest weaknesses or strengths at achieving desired generalized program outcomes within the complicated authentic context of the lives of students with disabilities. The Challenge in Florida The efforts of Florida's Division of Blind Services (DBS) to meet the challenge of preparing young adults for postschool employment and independent living were detailed by Jorgensen-Smith and Lewis in 2004. They described the lessons learned through a pilot project for which DBS provided funding to local Community Rehabilitation Programs (CRPs) to support summer transition training. This project was carefully planned over a 3-year period during which assessment tools were developed, training was provided, and group processes were used to create a statewide implementation of services that adhered to basic principles and policies yet was flexible enough to meet local needs. In creating and defining the Summer Transition Program, DBS provided funds for the CRPs to create the necessary series of planned instructional activities and meaningful, relevant events for students ages 14 to 21. The foundation of the Summer Transition Program's planned instruction was the Transition Tote System (Wolffe & Johnson, 1997), published by the American Printing House for the Blind. The Transition Tote System consists of a tote case for organizing materials, a student manual, and an information supplement for use by instructors. The lessons in the student manual and information supplement are designed specifically to facilitate the development of transition skills for students with visual impairments. The lessons guide the student with visual impairment through activities that assist with self-awareness, work exploration, job-seeking skills, and job-keeping skills. Similar, but not identical, programs were implemented at the three CRPs selected to pilot the Summer Transition Program during its first 2 years. Instructors facilitated students' learning on the Transition Tote System lessons through group presentations and individual study for at least part of most days. Activities to develop technology skills, living skills, recreation skills, and work experiences filled the remainder of the participants' time. (For a full description of the planning and 1st-year implementation of the Florida Summer Transition Program, see Jorgensen-Smith & Lewis, 2004.) The members of the program's planning team recognized that preparing for transition is a process that occurs over time and involves first the introduction of skills and new ways of thinking about oneself, then the incorporation of those skills and attitudes into one's naturally occurring behaviors within an environment of high expectations for self-determination and personal achievement. They believed that effective transitions occur when students have been repeatedly engaged in a series of planned instructional activities and meaningful, relevant events that help them to internalize positive beliefs about themselves, a realistic appreciation for their abilities, and a plan for future involvement in work, home, and community. Based on these convictions, it was conceived that students would attend the Summer Transition Program over a period of years, gradually gaining in vocational skills, self-knowledge, confidence, and independence. It also was determined that one component of the formative program evaluation process would be the change in students' skills from one year to the next. Evaluation of Student Skills Though it was tempting to immediately measure postprogram student outcomes, the planning team was convinced that these measures would not reflect the desired long-term changes in skills and attitudes that DBS hoped to generate. It was determined, instead, to assess students' perceptions of their transition skills and abilities once each year and to use this annual assessment for individual program planning. DBS sought, but could not locate, a tool for assessing the specific competencies needed by students with visual impairments as they transition to adult life. The agency, therefore, commissioned Wolffe (2002) to develop a Transition Competencies Checklist (TCC) based on current research in the area of transition and the specialized needs of young adults with visual impairments. Wolffe's final product is a tool that requires students to evaluate their knowledge and involvement in activities related to development of the following 10 competencies: * An understanding of work based on real life experiences * Well-developed leisure and socialization skills * Well-developed problem-solving skills * Application of self-advocacy skills * Application of compensatory skills * Knowledge of career options and sources of information * An understanding of levels of ability and impact with regard to job placement * Mastery of career counseling content areas * Self-awareness * Career exploration * Job-seeking skills * Job-maintenance skills * Employment skills * Evidence of participation in work experience opportunities * An understanding of employers' concerns The areas addressed by the TCC (Wolffe, 2002) represent the array of academic, social, vocational, and personal needs that have been identified in the transition and career education literature as being key to adult success (e.g., Brolin, 1995; Clark & Kolstoe, 1995; Rusch & Chadsey, 1998; Wehman, 2001). The TCC incorporates the components of an effective transition assessment (Miller et al., 2007) in that it provides “information regarding the strengths, limitations, and motivations” (p. 5) of a particular student. Because the TCC taps into students' perceptions of their own skill levels, it is more likely to result in a student-centered plan for transition that engages students' natural motivations and is relevant (Miller et al.). Use of the TCC provides those involved in transition—teachers, families, and the students themselves—with an important source of information to assist in the determination of the domains in which instruction is needed to facilitate an effective transition from school to work for a particular student. DBS decided to use the checklist as a means (a) of monitoring students' annual progress toward preparation for work and (b) for holding the Summer Transition Program accountable for its activities. The use of this self-evaluation tool for monitoring students' development of transition skills was of particular interest to the authors. Research Questions The present research was based on the assumption that involvement in the Summer Transition Program during one summer, followed by a year of naturally occurring opportunities to practice newly acquired transition skills and attitudes, would lead to changes in students' reports of competencies. The following hypotheses were made: * Students' ratings of their understanding of work based on real life experiences will increase. * Students' ratings of their social/leisure skills will increase. * Students' ratings of their problem solving skills will increase. * Students' ratings of their use of self-advocacy skills will increase. * Students' ratings of their use of compensatory skills will increase. * Students' ratings of their knowledge of career options and sources of information will increase. * Students' ratings of their future level of dependency related to work will increase. * Students' ratings of their mastery of career counseling areas will increase. * Students' ratings of their overall transition competencies will increase. Based on the bodies of literature on transition and visual impairment, it was also hypothesized that (a) gender differences would be evident in the perceived transition skills of participating students; (b) the overall transition competency reported by braille readers would differ from the transition competency reported by print readers; and (c) the overall transition competency reported by individuals who had worked for pay would be higher than those students who had not worked at paid employment. Two of the 10 transition competency areas included in Wolffe's TCC related specifically to students' direct experiences with work. Because not all participants had paid or unpaid work experiences, items included in the two categories “evidence of participation in work experience opportunities” and “an understanding of employers' concerns” were not included in the analysis described below. Methods Participants TCCs, completed approximately 1 year apart, were available for 22 students. The earlier checklist was completed prior to the students' entry into their 1st year of participation in the Summer Transition Program and had been used to identify areas of need specific to each student. The second checklist was completed prior to the students' 2nd year of participation in the program. Some students (n = 8) participated in the Summer Transition Program in 2002 and 2003, whereas others (n = 14) participated in the programs offered during 2003 and 2004. Information about the participants is summarized in Table-1. Of the 22 youth, 12 (54.5 percent) were females and 10 (45.5%) were males. Seventeen of the participants (77 percent) were classified as White; of these, 9 were females and 8 were males. The four African American teens (18%) were divided equally between males and females. One Hispanic female also participated. During the first year in which they participated in the Summer Transition Program, the students ranged in age from 13 to 21 (mean = 15.68, standard deviation = 0.38; median = 15.60; mode = 15.00). Obviously, during the next year, these students' ages changed. One of the males was a braille reader, as were five of the females. The remainder of the students reported using regular print (1 male and 2 females) and large text (8 males and 5 females) to access information. All were legally blind. Table 1. Participant Characteristics Participant Cohort Age During 1st Year Race/Gender CRP Location Reading Medium Career Goal Work Experience- A 1 16 White/F 1 BR Customer service Yes B 1 17 White/F 1 LP Veterinarian technician Yes C 1 14 White/F 1 BR Customer service Yes D 1 17 White/F 1 BR Customer service No E 1 15 White/F 1 LP Medical assistant No F 1 16 Hisp./F 1 LP Occupational therapist Yes G 1 15 Af.A/M 1 LP Interior designer No H 1 15 White/M 1 LP Child care worker No I 2 15 White/M 2 RP Communications No J 2 17 White/M 2 LP Actor or artist No K 2 21 White/M 2 LP Animal caretaker No L 2 14 White/F 2 LP Undecided No M 2 14 Af.A /M 1 LP Undecided No N 2 18 Af.A /F 2 RP Special education teacher No O 2 16 White/F 3 BR Physical therapist Yes P 2 16 White/F 3 RP Pediatric nursing Yes Q 2 13 White/M 1 LP Lawyer Yes R 2 17 White/M 3 BR Ministry or record company Yes S 2 16 White/F 2 BR Special education teacher Yes T 2 15 White/F 1 LP Cook No U 2 15 White/M 3 LP Undecided No V 2 13 White/M 2 LP Career counselor No Note. BR = braille reader; LP = large print; RP = regular print; Hisp. = Hispanic; Af.A. = African American. Summer Transition Program Each of the participating students was involved in a Summer Transition Program that was sponsored and funded by the Florida DBS but was provided through a local agency that traditionally offers services to individuals (usually adults or preschoolers) with visual impairments. DBS provided the general framework for the Summer Transition Program and guidelines to these agencies with regard to (a) criteria for quality of instructional personnel, (b) ratio of instructional personnel to student participants, (c) the exclusion of advocacy-level clients, and (d) minimum amount of contact time (Jorgensen-Smith & Lewis, 2004). Additionally, agencies were required to design activities to meet the unique and specific needs of the students who were enrolled, as long as they reflected the principles of the Transition Tote System (Wolffe & Johnson, 1997). In following best practices for individualized instruction, no two students, even those participating in the project during the same year and through the same CRP, received the same intervention. Instrument The TCC is a self-evaluation tool. Indicators for each of the 10 transition competency areas are presented in a list (see Figure-1 for sample items in each category). Individuals completing the checklist are asked to think of examples in their lives that are reflective of the indicator and respond yes if that indicator describes their life experience or no if it does not. The number of indicators for each competency area varies from 6 (competency no. 1) to 64 (competency no. 8). Although the total number of items is large, the time to complete the checklist is manageable, because the response choices are limited to yes and no. The TCC was available to students in print and in an electronic form. For some students, adults read the items aloud and recorded responses. Fig. 1. Sample items on Transition Competency Checklist. For purposes of this analysis, the authors carefully reviewed the TCC and eliminated those items for which comparison of growth measures was not possible. For example, the indicators “I walk with a cane” and “I walk without a cane” were eliminated. Although the decision to use a cane might be considered an indicator of growth for an individual, comparison of the decision made by one individual with another would not have been meaningful. Another type of indicator not used in the analysis is exemplified by the item “I like to go to the movies.” It would not have been possible for the researchers to determine whether a change in this type of behavior reflected growth or not. In contrast, items such as “I can read a map,” “I consider several solutions to my problems,” and “I budget my money” were retained. Table 2 provides information about the numbers of indicators in each category and the number of indicators used in the data analysis. The complete list of indicators used is available from the first author. Table 2. Analysis of Differences in Ratings from Year 1 to Year 2 in Eight Transition Areas and Overall Transition Competency[a] Transition Competency Area N Observed Value of T Table Value of T Result Understanding of work based on real life experiences (5/5 items used) 12 min{96.5, 16.5} 17 Accept at .05 (one-tailed) Social and leisure skills (16/26 items used) 16 min{85, 49} 36 Reject at .05 (one-tailed) Problem-solving skills (9/9 items used) 14 min{45, 60} 26 Reject at .05 (one-tailed) Self-advocacy (6/6 items used) 14 min{86, 16} 26 Accept at .05 (one-tailed) Application of compensatory skills (27/29 items used) 21 min{138.5, 92.5} 68 Reject at .05 (one-tailed) Knowledge of career options (6/6 items used) 19 min{146, 44} 54 Accept at .05 (one-tailed) Ratings of their future level of dependency (9/11 items used) 14 min{24.5, 80.5} 26 Accept at .05 (one-tailed) Mastery of career counseling areas (45/63 items used) 19 min{150.5, 39.5} 54 Accept at .05 (one-tailed) Ratings of their overall transition competencies (123/155 items used) 17 min{119, 34} 41 Accept at .05 (one-tailed) The N is reduced by the number of pairs for which di = 0. T = Wilcoxon's T. If the observed value of T is equal to or less than the critical value of T reported in a table of the distribution of the Wilcoxon's T, then the two samples can be said to differ significantly. Data Analysis Data were available for 22 individuals who participated in the Summer Transition Program for 2 years in a row. About one third of the teens (n = 8) participated during the years of 2002 and 2003, whereas the other two thirds (n = 14) participated during 2003 and 2004. The researchers were interested only in changes in the students' self-reported transition competencies from when they completed the TCC before beginning their 1st year of the summer program to the time when they completed the checklist again, before the start of their 2nd summer in the program. Before analysis, scores were transformed, if necessary, so that changes in the positive direction were scored similarly. For example, a negative response to the item “I have trouble keeping my clothes clean” was transformed so that it could be counted as a positive indicator of an application of a compensatory skill. The Wilcoxon Matched-Pairs Signed-Ranks Test was used to compare the results of ratings of competencies for participants from one year to the next. This nonparametric statistic was selected because it could not be assumed that a normal distribution existed or that the variance would be homogeneous. An alpha value of .05 was selected a priori as acceptable to demonstrate significant differences between the mean scores. Due to the unidirectional focus of the research hypotheses, the alpha value was computed using a one-tailed null hypothesis. Descriptive statistics describing group differences at the time of the second administration of the TCC were used to make comparisons based on gender, mode of reading (braille or print), and work experience. Findings The results of the data analysis with regard to the differences between students' ratings of their competencies 1 year after the Summer Transition Program can be found in Table-2. Students' ratings of their overall transition competencies were found to have increased at a statistically significant level. Similarly, significant differences in the predicted direction were found for students' ratings of their understanding of work based on real-life experiences, their knowledge of career options, self-advocacy, their mastery of career counseling areas, and their estimation of future level of dependency. No statistically significant differences were found in students' ratings of their social skills, problem-solving skills, or application of their compensatory skills. The mean of the overall transition competency scores of the students (n = 8) who indicated that they had paid work experience (mean = 73.69; standard deviation = 22.43) was compared with the mean of the ratings of the students (n = 9) who stated that they had not previously worked (mean = 70.44; standard deviation = 16.48). The difference between these two means was small, only 3.25 points. Although there was considerable variance in the scores, especially among the students who had work experience, the medians were similar (73.5 and 75.5). These data appear to support the finding of no differences in the overall transition competency scores of students who did and did not have work experience. Similarly, the differences in the means of the overall transition competencies of the students who were braille readers (n = 5) and print readers (n = 12) and between males (n = 7) and females (n = 10) at the beginning of the 2nd year were negligible. Braille and print readers achieved almost identical mean scores on the TCC (71.83 and 72.30), though the median scores were separated by 7.75 points, with greater variability among the scores of the braille readers (standard deviation was 22.94 compared with 16.48 for the print readers). Male participants demonstrated greater variability than did the female participants (standard deviation = 21.53 for males, 15.92 for females), but the mean difference between these two groups was small (2.62 points), as was the difference in median scores (75.5 and 73.5). Discussion The results described here suggest that 1 year after having been involved in a summer program focused specifically on developing competencies related to improving social, academic, personal, and vocational skills, participating students' perceptions of their overall abilities in the area of transition had improved. Specifically, students reported perceiving that their skills had increased in the categories of (a) understanding work based on real-life experiences, (b) self-advocacy, (c) knowledge of career options, and (d) mastery of career counseling areas. They also perceived that they would be less dependent than they had thought the previous year. Because students completed the second TCC nearly 9 months after having participated in the Summer Transition Program, the changes described above cannot be attributed to their participation in that program; the career education or transition activities to which teachers and parents exposed them during the intervening year are unknown. In addition, because there was no control group of students, it cannot be known whether the identified changes were due to the maturation of the participants. Given that they were a year closer to graduation, it may be assumed that greater emphasis had been placed on these areas. Unfortunately, this assumption may not be valid, because there is evidence that teachers of students with visual impairments are not including career education activities in their delivery of services to their students (McKenzie & Lewis, 2008; Wolffe, Sacks, Corn, Huebner, & Lewis, 2002). Further support of the possible role of the Summer Transition Program in these findings of significant difference is that it was the areas not directly related to work (i.e., social and leisure skills, use of problem-solving skills, and the application of compensatory skills) that students did not perceive to have changed over the year. If the TCC had measured only typical maturation of these skill areas, then one would have expected students to have shown growth in all domains. One explanation for the lack of perceived growth in these areas is that all of the CRPs used the Transition Tote System (Wolffe & Johnson, 1997) as the basis for individual and group instruction. This curriculum includes 30 lessons related to self-awareness, work exploration, job-seeking skills, and job-keeping skills. It does not provide lessons specifically designed to improve the kinds of skills that support involvement in work, such as social skills and activities of daily living, access to print, and travel skills, which Wolffe (2002) categorized in the TCC as compensatory skills. Each CRP was to have included instruction and practice in these areas, but without a specific curriculum, it is possible that the lessons were fragmented and not as effective. It is also possible that independent travel and personal management (e.g., use of calendars, cooking, shopping) were less likely to be practiced once the Summer Transition Program concluded, so any real changes that might have occurred were lost between the two assessments. That no differences were found in the overall transition competencies of students based on mode of reading, prior work experience, and gender was somewhat surprising. Prior studies have identified significant differences in the employment rates of individuals who are blind and those who have low vision. For example, Houtenville (2003) and Shaw, Gold, and Wolffe (2007) found that people with low vision had higher employment rates than people who are blind. Previous researchers also have reported that males and females with disabilities tend to demonstrate differences with regard to their performance and success in many of the areas associated with successful transition skills, including academics (Wagner, 1992), independent skills (D'Amico, 1991), and social adjustment (Newman, 1991; Wagner, Cadwallader, & Marder, 2003). These differences between genders also are reported in the population of nondisabled students (National Center for Education Statistics, 2002). It was anticipated that these differences would be reflected in the findings of this study. It appears as though this group of students, regardless of gender, level of visual functioning, and mode of reading, demonstrated similar levels of growth over the year. The finding of no differences in the overall transition scores in the groups of students with and without prior work experience also was unexpected. Work experience is emphasized as one of the critical components of a career education program for individuals with visual impairments (Wolffe, 1999) and has been found to have a positive relationship to gaining employment, according to the National Longitudinal Transition Study (Wagner, Newman, Cameto, Garza, & Levin, 2005). More than likely, this finding may be an artifact of the decision by the authors not to include the two sections of the TCC related to work experience in the overall transition scores. It is possible, however, that the limited work experiences of these mostly 15-year-olds with visual impairment were not sufficient to generate the changes in self-perception in this area of the TCC. If true, then increased attention to work experience may be needed for students involved in community and school transition programs. Limitations Several limitations prevent the careful reader from generalizing these findings to other groups of students with visual impairments. There may have been bias in the selection of students who were willing to participate in the Summer Transition Program and certainly, those students who chose to return for a 2nd year were probably different from nonparticipants or participants who were involved for only 1 year. In addition, the findings are based on self-reported data, which may not accurately reflect the reality experienced by the participants. Lack of a control group limits the understanding of the impact of maturation on the skill areas of interest. Finally, there is no evidence that supports the use of the TCC as a valid or reliable instrument for measuring the areas of interest or for use as a program evaluation tool. Most significantly, almost 9 months elapsed between the students' involvement in the Summer Transition Program and the students' second completion of the TCC. The researchers did not attempt to control the many factors that had the potential to influence students' perceptions of their skills and confound the findings. In some ways, this approach is more authentic, because it replicates the real conditions under which students acquire skills and aptitudes. Still, the most that can be said of these findings is that a summer transition program, followed by a typical school year, may result in students' improved perceptions of many transition competencies. Conclusion This study was designed to investigate changes in students' perceptions of their generalized functioning in several areas related to successful transition to adult life as one measure of the success of a summer transition program. During the period between the two administrations of the TCC, the students in this sample perceived that their overall competency related to key skills associated with successful transition had improved. Although no association between these changes in perception and involvement in the Summer Transition Program is possible, the data suggest that differences occurred in the very areas that the program systematically targeted. Transition programs, such as this one, provide important opportunities to students with visual impairments that may not be otherwise addressed by teachers of students with visual impairments in school programs (Wolffe et al., 2002). Little is known about the career development of students with visual impairments. This study adds to the literature on the impact of specialized transition programs for students with visual impairments. It used a previously untested instrument to measure changes in students' perceived functioning as a means to evaluate one such special program. It appears that targeted skills can be retained over a period of time and that the benefits of less systematic instruction in related areas may not be as long lasting. Additional research is needed to confirm these effects, to determine an expected level of maturation in the area transition, and to identify why factors, such as gender, mode of reading, and prior work experience, did not influence the results. References Agran, M., Cavin, M., Wehmeyer, M., & Palmer, S. (2006). Participation of students with moderate to severe disabilities in the general curriculum: The effects of the self-determined learning model of instruction.Research and Practice for Persons With Severe Disabilities, 31, 230-241. 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Baltimore, MD: Paul H. Brookes Publishing Wolffe, K. (2002). Transition competencies checklist Austin, TX: Author Wolffe, K., & Johnson, D. (1997). Transition tote system: Navigating the rapids of life [Information supplement] Louisville, KY: American Printing House for the Blind Wolffe, K.E. (1999). Skills for success: A career education handbook for children and adolescents with visual impairments New York, NY: AFB Press Wolffe, K.E., Sacks, S.Z., Corn, A.L., Huebner, M.K., & Lewis, S. (2002). Teachers of students with visual impairments: What are they teaching-Journal of Visual Impairment & Blindness, 96, 293-304. ***Adapting Braille Instruction Practice Report Decoding the Braille Riddle: Adapting a Direct Instruction Reading Program Lynn Campbell, MA* School District of Oconee County, Walhalla, SC *Please address correspondence to lcampbell@oconee.k12.sc.us Abstract Many young students with visual disabilities have additional disabilities that present challenges for developing reading skills. The direct instruction model for reading instruction has been successful in helping sighted students develop initial reading skills, such as decoding. However, commercial programs based on this model often rely on visual cues, making them difficult to use with braille readers. The author describes the use of the Science Research Associates/McGraw-Hill Reading Mastery I program, a commercially available program based on the direct instruction model, with a young legally blind braille reader who has concomitant disabilities. Several adaptations to the program were made in order to accommodate for the student's visual disability, and the program proved effective in increasing the student's reading decoding skills. Keywords: braille instruction; reading; direct instruction; decoding Introduction The direct instruction model is an instructional method used in many school districts throughout the country. First implemented in 1968 as part of Project Follow-Through, an education initiative by the U.S. Office of Education, the program was developed by Siegfried Engelmann and other researchers at the University of Oregon. “The underlying assumptions of Direct Instruction include: (a) all children can be taught; (b) the learning of basic skills and their application in higher-order skills is essential to intelligent behavior and should be the focus of an instructional program; and (c) disadvantaged students must be taught at a faster rate than typically occurs if they are to succeed in school” (Education Commission of the States, 1999, p. 3). This article discusses the use of the Science Research Associates (SRA)/McGraw-Hill Reading Mastery I program, a commercially available program based on the direct instruction model, with a young legally blind braille reader who has concomitant disabilities. The instructional program focused on improving the student's reading decoding skills. As described here, the student initially developed good sound and symbol association and the recognition of initial consonants but had difficulty in mastering more advanced decoding skills, such as blending and segmentation, which are important for the development of literacy skills. Although the SRA Reading Mastery I program uses a number of visual clues to assist the early reader with decoding skills, simple adaptations of the program made for the braille reader proved to be quite successful in helping the student achieve these skills. This article describes the adaptations that were made to the SRA Reading Mastery I program by the author to enable its use with a braille reader. It is important to note that the instructional program described herein was designed to specifically increase decoding skills in a student who struggled with the development of these skills. It is not recommended for use as a total literacy program, nor is the particular commercial direct instruction program used endorsed by the author. Rather, this article describes how a visually oriented direct instruction program can be successfully adapted for use with a braille reader in order to increase the student's decoding skills. Using the types of adaptations described, it may be possible for teachers to tailor other direct instruction programs for use with braille readers. Review of Literature Many sources document the importance of decoding skills in early readers and the failure of students to develop literacy skills if they struggle with decoding. Snider and Tarver (1987) report that students with learning disabilities experience failure in developing reading comprehension skills because their attention is focused on word recognition rather than on the development of knowledge. Using Chall's five-stage model of reading development, Snider and Tarver make the case that accurate decoding skills are necessary as a prerequisite to the development of fluency, which in turn is necessary for the acquisition of knowledge (Stage 3 of Chall's model) that is an essential component of reading comprehension. Lovett, Warren-Chaplin, and Ransby's (1990) research demonstrated that specific training in letter-sound knowledge and attention to regular and exception words resulted in an increase in word recognition skills of disabled readers. Literature related to individuals with blindness or visual impairment also demonstrates the importance of decoding skills for blind readers. Steinman, LeJeune, and Kimbrough (2006) used Chall's model to compare the development of reading skills in children who are blind and sighted, and they report that the stages of the model correspond to the reading development of braille readers as well as that of sighted print readers. Other sources emphasize the importance of phonological processing on early stages of braille reading (Gillon & Young, 2002; Pring, 1994; Wormsley & D'Andrea, 2000). There is also a great deal of research-based literature available on the topic of direct instruction, including publications supporting the use of direct instruction programs (Schug, Tarver, & Western, 2001; Viadero, 2002) and those critical of its benefits (Ryder, 2003; Thames, Kazelskis, & Kazelskis, 2006). However, a search of the literature revealed no publications specifically related to the use of direct instruction reading programs with visually impaired students. Inquiries made on two listservs for teachers of visually impaired students also produced no responses on this topic. Description of Subject At the time of the implemented instruction, my student, Lucy (not her real name), was 8-years old. She has diagnoses of retinopathy of prematurity and glaucoma. Her visual functioning is limited to light perception and some color vision, which she uses to some extent in orientation, but she has little or no functional vision for print. In addition to her visual impairment, Lucy demonstrates delays in all areas of development, especially in speech/language and cognitive skills. Both receptive and expressive language skills were affected by complications of prematurity, and through her kindergarten year, Lucy's expressive communication consisted primarily of echolalia. Another huge challenge for Lucy is that she lives in a rural environment and has led an extremely sheltered life. She has not had many of the life experiences that are so vital for the blind child in developing concepts and linking prior knowledge to comprehension of stories. The combination of her speech/language disability, limited experiences, and lack of visual ability to use picture cues has presented tremendous challenges to Lucy's development of early literacy skills. In terms of cognitive skills, on measures of achievement, Lucy functions several grade levels below her peers. In her early years, Lucy was suspected of having autism due to her communication deficits and autistic-like characteristics, but autism was ruled out after evaluation by a school psychologist with expertise in evaluating students with visual impairments. Lucy requires that tasks be broken into small steps and frequent repetition in order to master most concepts. Lucy has good tactual skills and is a tactual learner. When concepts are presented in a tactile form, Lucy generally learns them much more quickly than when provided with auditory input only. In addition to her good tactile discrimination skills, Lucy's strengths include excellent hearing and auditory localization skills, very good rote memory skills, and an impressive musical gift (she demonstrates perfect pitch, a lovely singing voice, and a facility for rhythm). Lucy's literacy instruction began in her preschool special needs classroom when she was 3-years old with a special education classroom teacher and the vision teacher who was my predecessor in Lucy's case. The Patterns Pre-Braille Series and other materials were used to build her tactile skills and basic concepts through her first kindergarten year, when I began teaching Lucy. She was retained in kindergarten, and during the second year, we progressed to the “Red” (Readiness) level of the Patterns Reading Series. Lucy had good sound/symbol association and could identify initial consonants fairly readily. She mastered the initial-letter contractions introduced in the Readiness level of Patterns and in her first-grade year passed five out of eight sections of the Post-Test for that level (the sections she did not pass were Concept Development, Listening Comprehension, and Listening Reading Comprehension). Lucy was also able to identify rhyming words. However, as we moved into the “Blue” (Preprimer) level of the Patterns series, Lucy had difficulty reading words that contained more than one letter other than the few multiletter words that were introduced in the Patterns Readiness level. Lucy was able to memorize the dot numbers for the contractions for consonant blends (e.g., “th,” “ch,” and “wh”), but she was unable to decode words that contained these contractions. It became clear that Lucy would need more explicit phonics instruction than is provided in the original Patterns series in order to master blending and other advanced decoding skills. Choice of Instructional Program In researching other instructional materials at that time, I learned that our school district's special education program utilized the SRA Reading Mastery and Corrective Reading programs as the main reading/writing curricula for students with learning and cognitive disabilities. I reviewed the program and at first rejected it because the instructional materials seemed to rely so heavily on visual cues. I also discovered that although the higher-level SRA programs (such as the Corrective Reading Program) were available in braille, the Reading Mastery I program was not. However, the program was reported to be very successful with the sighted students in special education in our district, so I decided to try to adapt the program for use with Lucy. Description of Instruction and Adaptations The SRA Reading Mastery I Program consists of 160 scripted daily lessons that teach basic decoding and comprehension skills. Decoding activities include sound pronunciation, sequencing, oral blending, rhyming, symbol identification (as sounds), saying words slowly, saying words fast, reading vocabulary (word lists), story reading, and independent workbook practice. Comprehension activities include picture comprehension, sequencing events, comprehension of vocabulary words, oral comprehension questions, and written comprehension activities (Engelmann & Bruner, 1995). Presentation books are used by the teacher and include the script for each lesson and display material for students. The display material is the most visual aspect of the program. In addition to providing picture cues, the presentation book shows the sounds and words the students are to read, with many visual cues provided. The main cue is in the form of a line under a sound or word, with a large dot on the left end of the line and an arrow on the right end. When presenting the sound or word, the teacher runs a finger along the line, indicating whether the student is to say the sound/word slow or fast (depending on the task for that lesson) and blending the sounds to decode words. Other visual cues include the following: marks to indicate long and short vowel sounds, variations in the appearance of letters to provide extra information to help in decoding, and the presentation of words in various fonts in order to prepare students for reading text with various font styles as it may appear in books and other written materials (including handwritten text). For example, all words at the Reading Mastery I level are written in lowercase, presumably to decrease the number of letter forms the students are required to recognize as they build early reading skills. As another example, in words with a silent “e” at the end of the word that modifies the vowel in the middle of the word, the lowercase “e” is written smaller than the rest of the letters in the word, and the student is taught to recognize the word as a whole word without focusing on the final “e.” Since Lucy has some residual vision, I initially attempted to present both braille forms of the text and greatly enlarged print forms. Eventually, however, I determined that the different print styles were confusing to Lucy, and she did not demonstrate enough visual efficiency to make good use of the print forms. From that point on, I presented only braille forms of all the printed materials. My major challenge then became one of providing Lucy with the same information that sighted students received from the visual cues. I was able to achieve this primarily through auditory modeling. I would say the sound or word the way I wanted Lucy to say them, then I had Lucy repeat them while feeling the braille symbols. I taught her what it meant to say them “slowly” or “the fast way,” and after that I was able to tell her before reading which way she should read a sound or word. Lucy also learned the terms “long” and “short” vowels, and again I could give her a verbal indication as to which form to use before reading a sound or word. Eventually, Lucy internalized many decoding rules and could read sounds and words without the auditory cues (with occasional reminders). One of the aspects of the Reading Mastery program that lent itself well to braille instruction was the presentation of consonant blends. Many of these blends, such as “th,” “sh,” and “ch,” have a contracted form in braille, so Lucy was able to learn the braille contractions at the same time that she was mastering the sounds of the blends. During the course of the Reading Mastery instruction, I introduced contractions as they appeared in the lessons. The controlled vocabulary and frequent repetition of the Reading Mastery lessons ensured that Lucy had sufficient practice with the contractions to master them without difficulty. One interesting aspect of Lucy's instruction in these blends was related to her speech deficits, which caused her to pronounce the “th” sound as “f.” It was difficult for Lucy to discriminate the difference between the two sounds when reading, and I was unsuccessful in teaching her to pronounce the “th” sound during reading instruction. Lucy's speech therapist tried using a flavored tongue depressor and encouraging Lucy to stick her tongue out to taste it while voicing the sound, and this did the trick! Lucy soon was able to pronounce the “th” sound consistently and no longer confused the two sounds when reading. Reading Mastery lessons were conducted daily with Lucy. Each session lasted approximately 45-minutes and consisted of a scripted lesson and guided practice on the corresponding workbook page. If we did not have time to finish the workbook page, she would finish it later in the day with the assistance of her full-time paraprofessional. Although in our district SRA instructional sessions are often conducted entirely by paraprofessionals working with small groups, I felt strongly that Lucy's lessons should be conducted in a one-on-one format by a certified teacher of students with visual impairments. It was critical that while learning reading skills, Lucy also developed good braille reading habits, such as correct hand position with two-handed movement, tracking, and concepts of braille page formatting. There were also many instances in which I was able to recognize that a braille recognition error or reversal was responsible for mistakes in Lucy's reading, and someone unfamiliar with the braille code and braille reading techniques would not have the background knowledge to make those determinations. In general, the direct instruction methods used in the Reading Mastery program were very effective with Lucy, who needs explicit instruction and frequent practice and repetition to master new skills. The workbooks and additional workbook practice pages, while geared to a very low taxonomic level, nevertheless provided Lucy with beneficial practice in both decoding and braille writing skills. In completing workbook pages, I required that Lucy use the contractions that she had learned since her good rote memory skills made it easy for her to remember the dot numbers for these contractions. In separate spelling activities, Lucy learned the English spelling of grade-level words along with the braille spelling, but in her general writing, I wanted to get her “thinking in braille” as early as possible. With other students in the future, I will consider the use of uncontracted braille in SRA lessons if it seems appropriate for a particular student, but as mentioned previously, the sequence of skills in the Reading Mastery program lent themselves well to the introduction of contractions, and Lucy had already demonstrated the ability to learn and remember the contractions, so using contracted braille was determined to be the best course for her. Reading Comprehension Although the Reading Mastery program provides some activities to build reading comprehension skills, I found this to be the least effective aspect of the program for a student who is blind. The stories presented in the story-reading activities use very controlled vocabulary at the occasional expense of relevant material. Some of the stories contain implausible content, such as a fat man who rides a goat down a hill and an eagle that sits under a tree and eats cake, ham, and corn. In many cases, I could find no way to make the content understandable to Lucy, especially given her speech/language disability. However, the reading comprehension activities in the practice workbooks did provide Lucy with some basic practice in answering simple comprehension questions about short passages and completing fill-in-the-blank exercises. Lucy also enjoyed reading the storybook stories, which increased her motivation for reading. For this reason and to build Lucy's decoding skills and tactual reading techniques, I continued to use the storybook stories, but I also used the Preprimer level of the Patterns series to work on comprehension and to increase Lucy's knowledge of braille contractions. In hindsight, Lucy's comprehension skills could have been further improved with the use of authentic literature and leveled readers along with the Reading Mastery and Patterns programs, and, as noted here, in her later school years I was able to provide these opportunities with the benefit of increased knowledge of the latest trends in reading research. Longitudinal research conducted by Thames et al. (2006) also demonstrated that the use of the Reading Mastery program did not result in significant gains in reading comprehension skills for sighted students. This confirms my opinion that the Reading Mastery I program is helpful for teaching decoding skills, especially for students with blindness who struggle to attain these skills initially, but it should not be the sole reading instruction program provided to these students. Students who are blind will also benefit greatly from a rich language environment, experiential learning, and the use of authentic literature to help them develop reading comprehension skills as they improve their decoding skills and fluency. Summary and Recommendations for Future Research Data are not available on the exact time frame for the completion of the Reading Mastery I program for Lucy. However, since one lesson was completed in each daily instructional session, it took 160 sessions to complete the entire level. I would estimate that given the school year of 180 days, since there could not be instructional sessions on every school day, Lucy completed the program in the period of one school year plus one quarter. Lucy finished the Reading Mastery I program in her second-grade year and was able to pass all the mastery tests contained in the program with 90 to 100 percent accuracy. These mastery tests included decoding of consonant blends and vowel digraphs in multisyllabic words and recognition of basic sight words and simple irregular words (such as “want,” “some,” and “one”). At the conclusion of the program, we were able to return to the use of the Patterns series, and Lucy was able to pass four out of five sections of the “Blue” (Preprimer) Post-test in her third-grade year (the only section she was not able to pass was Reading Comprehension, although she scored close to mastery on that section). At the same time, she scored at the Primer level of a standardized achievement test that is available in braille. The Reading Mastery program also helped build Lucy's spelling skills, although it did not give her an opportunity to develop other writing skills, such as sentence construction and the ability to choose a topic to write about. I feel that the direct instruction approach of the program was very effective in Lucy's case for providing her with these discrete skills. However, because of the limitations of the program as an overall reading instruction program, I did not feel it would be to her benefit to continue into the higher levels of the SRA program at that point in Lucy's education. After completion of the Reading Mastery I program, I used a combination of the Patterns series, a basal reader, and leveled readers to build Lucy's reading skills and various best-practice strategies for improving her overall literacy skills. Her reading skills have steadily increased, and she has had no further difficulties with decoding skills. Lucy is now in middle school, where her special education classroom teacher is using the Reading Mastery Plus Level III program for her primary reading instruction. Our school district is also successfully using the Reading Mastery II program (the level that follows Reading Mastery I) with another braille student who recently showed gains of over one and a half years in oral reading and reading comprehension skills in a 1-year period, as measured by the same accessible achievement test that has been used with Lucy. Although these higher SRA levels are somewhat less reliant on visual cues than the Level I program, we are using the lessons learned from Lucy to continue to adapt the programs for the braille reader. Additional research in this area should include (a) assessment of the use of SRA and other direct instruction programs, using the adaptations presented in this article, with a larger sample of blind and visually impaired students to determine the effectiveness of the direct instruction method with this population of students; (b) the study of other types of adaptations of direct instruction programs for students with blindness or visual impairment; (c) assessment of the use of direct instruction programs with low-vision students using optical devices and/or large print; (d) development of strategies to build comprehension and written expression skills in students who are receiving direct instruction in decoding in order to provide them with a balanced literacy program; and (e) assessment of other reading instruction programs (using non–direct instruction methods) that include explicit phonics instruction as part of an overall reading program that also emphasizes reading comprehension and fluency. In summary, the success of the adapted SRA Reading Mastery I program in improving Lucy's decoding skills demonstrates that a highly visual direct instruction program can be adapted for use with a braille reader. I plan to use the adaptations with other students with blindness who may need a direct instruction format in order to benefit from literacy instruction. References Education Commission of the States. (1999). Direct instruction Denver, CO: Education Commission of the States: (ERIC Document Reproduction Services No.-ED 447 424). Engelmann, S., & Bruner, E. (1995). Reading mastery presentation books A–C Worthington, OH: SRA Macmillan/McGraw-Hill Gillon, G.T., & Young, A.A. (2002). The phonological-awareness of children who are blind.Journal of Visual Impairments and Blindness, 96, 38-49. Lovett, M.W., Warren-Chaplin, P.M., & Ransby, M.J. (1990). Training the word recognition skills of reading disabled children: Treatment and transfer effects.Journal of Educational Psychology, 82, 769-780. Pring, L. (1994). Touch and go: Learning to read braille.Reading Research Quarterly, 29, 61-74. Ryder, R. (2003, October). Results of direct instruction reading program evaluation longitudinal results: First–third grade. 2000–2003 Milwaukee, WI: University of Wisconsin, Milwaukee Schug, M.C., Tarver, S.G., & Western, R.D. (2001). Direct instruction and the teaching of early reading.Wisconsin Policy Research Institute Report, 14, 1-31. Snider, V.E., & Tarver, S.G. (1987). The effect of early reading failure on acquisition of knowledge among students with learning disabilities.Journal of Learning Disabilities, 20, 351-356. Steinman, B.A., LeJeune, B.J., & Kimbrough, B.T. (2006). Developmental stages of reading processes in children who are blind and sighted. Journal of Visual Impairments and Blindness, 100, 36-36. Thames, D., Kazelskis, R., & Kazelskis, C.R. (2006, November 8–10). Reading performance of elementary students: Result of a 5-year longitudinal study of direct reading instruction Paper presented at annual meeting of the Mid-South Educational Research Association, Birmingham, AL. Viadero, D. (2002). Studies cite learning gains in direct instruction schools. From: http://www.readingrockets.org/article/411 Wormsley, D.P., & D'Andrea, F.M. (2000). Instructional strategies for braille literacy New York, NY: AFB Press ***Dr. Spungin Interview Interview A Wealth of Experience and Contribution: An Interview with Dr. Susan Spungin Jane N Erin, PhD* University of Arizona, Tucson, AZ *Please address correspondence to jerin@u.arizona.edu Abstract On her retirement from the American Foundation for the Blind, Dr. Susan Spungin describes her experiences and insights about the professional field of work with people who are visually impaired. She came to the field through a fortuitous interest in braille music and initially worked as an itinerant teacher in California. At the American Foundation for the Blind, she was the first national specialist in education. More recently, her career has emphasized international activities, including her role as treasurer of the World Blind Union. During this interview, she recounts changes in the field that include evolution of technology, curricular and service changes in education, increased emphasis on braille literacy, and the development of the profession. Keywords: interview; Susan Spungin; history of visual impairment Introduction In 1982, I met Dr. Susan Spungin at one of the first Josephine Taylor Leadership Institutes. I was a doctoral student then, and I sat beside Dr. Kay Ferrell, who had a brand-new PhD in hand and was about to begin a job with the American Foundation for the Blind. When Dr. Spungin finished her keynote speech to the conference, I was in awe. She was eloquent, poised, and sometimes funny. She delivered a message of strength and purpose that was unlike any other speech I had heard. For the first time, I realized that our profession reached far beyond the boundaries of my own community to the common experiences of people with visual impairment throughout the world. When I left the room, it was with a new belief in the importance of what we could achieve as a field. However, it was years before I realized how many people have been similarly encouraged by her ability to motivate and inspire. When Dr. Deborah Gold, editor in chief of AERJ, asked if I would interview Dr. Spungin as she retired from her role as a vice president for international programs and special projects and treasurer of the World Blind Union at the American Foundation for the Blind (AFB), I recognized an opportunity to walk through the history of our field with a gifted leader. The experience was not very different from the first time I heard Dr. Spungin speak: She was articulate and reflective as she revisited the milestones of her professional life, and she conveyed both the challenges of the past and the potential of the future. After 44 years in the field of visual impairment, Dr. Susan Spungin has retired from regular work but will continue as a consultant for special projects at the AFB. She passes along a legacy of leadership that is unequaled in our field. The following is a summary of a stimulating discussion with an insightful leader and humanitarian. Professional Background Like many professionals, Dr. Spungin did not originally intend to become a professional in visual impairment. Dr. Spungin recalls her first quest for work after she completed a college degree in music at Skidmore College in Saratoga Springs in upstate New York: “I wanted to see San Francisco so I got into a Volkswagen Beetle and arrived in San Francisco with a friend. There I was told that I was underskilled and overeducated.” Her “dream job” turned out to be an errand girl at a telephone company where the only advantage was that she could wear sneakers on the job. This job was followed by a job balancing finances with American Express. When she discovered that San Francisco State University cost only $17 a credit, she enrolled in a master's degree program in music. She discovered the key to her future profession during a library search for a thesis topic. While searching a musical reference book, she found an entry about braille music. She was intrigued enough to seek out a braille music course, only to discover that literary, mathematical, and foreign language braille were prerequisites. Dr. Spungin recalled, “Everything changed after a call from Georgie Lee Abel, who told me about an itinerant teaching job in Daly City Schools teaching visually impaired students that I could do while taking courses in teacher preparation. I was ecstatic! No one had ever paid me to go to school before. Little did I know that I would one day be president of BANA when the Music Universal Braille Code Revisions were passed years later!” Soon her personal life led her back to New York City. Doors opened after Georgie Lee Abel telephoned Josephine Taylor at the New Jersey Commission for the Blind in 1967 and Dr. Bob Bowers at Columbia University. Soon she found herself in a doctoral program at Columbia while raising a young family. In 1972, Dr. Spungin was hired at the AFB as the first national specialist in education while she was completing her doctoral dissertation on educational competencies, defining the beginning of standards-based education for visually impaired students. She recalled, “I was the first married professional woman staff member, and the last person in the job who made major contributions to the field was Georgie Lee Abel! Everything I did seemed so easy because there was so little done since Georgie left. In my new AFB role, I was involved in the development of the regulations for PL94-142 and helped with defining the role of the teacher of the visually impaired. Since our field had been mainstreaming for years earlier that past knowledge was very helpful.” In 1975, Dr. Spungin was honored as the alumnus of the year at San Francisco State University as well as delivering unexpected twins. The award was particularly memorable because she passed out in the stadium from exhaustion as she was receiving the award, and she recalls people shouting in the stadium, “Unchain her!” (remember it was still the days of the college riots), as she was driven out of the stadium in the back of a station wagon. Changes in Services to People with Blindness and Visual Impairment When asked about the most important changes in educational services during her career, Dr. Spungin described several, most notably the increased numbers of all children with disabilities in public schools. She views this change as parallel with progress in other areas of the civil rights movement: “Mainstreaming/inclusion and the passage of ADA have helped our society become more inclusive for all people, and the impact on the acceptance of people who are different has been astounding. … The whole issue of civil rights has impacted everyone.” She noted important developments in curriculum, including Dr. Natalie Barraga's work in low vision disseminated through national workshops, the MAVIS social studies curriculum, the SAVI science curriculum, and interventions that resulted from Dr. Beth Stephens's work in Piaget, which led to new tools for observation and assessment of young blind children. Although most of the changes she described were encouraging, Dr. Spungin acknowledged that the development of new educational models has been both positive and negative. She expressed concerns about some of the changes she has seen: “The abuse of the itinerant model has resulted in limiting the necessary time needed to spend with the visually impaired student and in many cases, the itinerant model has morphed into a teacher consulting model, leaving no time for teaching the unique skills such as braille, training in the use of low vision aids, etc.” Dr. Spungin also mentioned the rapid development of technology, describing it as “a gift as well as a challenge.” She recalled her first exposure to assistive technology during the summer of 1967 at the Massachusetts Institute of Technology. At that time, technological innovations included spelled speech output, computer braille, and a travel device called the Russell's Pathfinder developed by Lindsey Russell as well as a device called the Visitoner, which substituted audible tones for printed material. The 1970s saw wider use of technology with the development of the Optacon, braille translation systems, and the laser cane: “I have seen the transition from long playing records to tape to compact disks to flash cards. Amazing! Receiving materials in a timely way has become a right, not a wish, not only for student textbooks but for the college and adult populations as well.” Dr. Spungin strongly acknowledged progress in braille literacy and, in general, access for all people who have visual impairments: “Things are better because the entire field has finally begun to come together, consumers and providers, which is the only way to make meaningful sustained change … in my youth it was print or braille—never the two shall meet. That has changed with the use of Learning Media Assessments to determine which or both.” She recalled the challenges of representing the AFB in seeking a common goal with the National Federation of the Blind and the American Council of the Blind as these organizations worked to increase braille literacy. Her presentation on literacy to the National Federation of the Blind conference in 1989 was especially significant. Not only did this collaboration result in several key publications to focus national attention on braille literacy, but it also introduced Susan to an important friendship with then-President Kenneth Jernigan and his wife Mary Ellen. Professionalism “I have seen a great change in the growth of professionalism in our field, much of it due to university program personnel. Many things AFB used to do no longer require our attention. It frees AFB to concentrate on other issues that impact not only the public but also consumers. Other specialty areas, such as physical and occupational therapists, are beginning to have a greater role with children and adults who are visually impaired. However, there is real concern regarding the lack of third-party payment for vision services when these funds are available for other therapists but not for our vision professionals. This remains a critical problem.” Dr. Spungin also commented on her deep love for the blindness profession and colleagues, whom she called “the most welcoming loving caring group of people in any professional field I have tried. We all share a common purpose which binds us together for the greater good. The fact that two professional organizations of educators and rehabilitators could form one group [AER] was and is amazing.” When asked about her advice to young professionals, Dr. Spungin said, “You will never be bored and will always have more than a job. You will always have a reason for being. Don't be afraid to ask questions of anyone or about anything as long as you do it with grace and sincerity.” Personal Satisfaction When asked about the most satisfying parts of her career, Dr. Spungin was typically modest in her response to a question that could include hundreds of accomplishments. “This is a very difficult question, but if pushed I would say the establishment of the National Association for Parents of Children with Visually Impairments. I also treasure my many years with AFB under Bob Barnett, Gene Apple, Bill Gallagher, and now Carl Augusto and, last but not least, my relationship with the National Federation of the Blind, especially Dr. Kenneth Jernigan, Mary Ellen Jernigan, and Dr. Mark Maurer.” With regard to the most enjoyable aspects of her job, she commented, “I enjoyed it all, but especially traveling, learning new things and meeting new people around the world. Further, I love controversy, negotiation, and working as part of a team to make a difference. I love writing—but only sometimes!” Future Plans “I will be staying in New York with trips to Long Island in our ‘country’ home. I am a native Manhattan person, having been born here and raised my family here—so I will never leave! I will continue to do some assignments for AFB and go back to music in my free time. I will miss the rush I get working for the field and AFB, but it is time to visit my 33-year-old twins and my 39-year-old daughter and their grandchildren (eight). It is time to prove to my children and my husband Peter that I can stay in one place for more than a week! I will miss all of you and wish you the best!” As an advocate, scholar, and leader, Dr. Spungin has motivated our profession to look beyond the present moment. Her insights are a reminder that professionals and people who are visually impaired can work together to ensure an improved quality of life. It is fitting that her retirement coincides with the year of celebration of Louis Braille's birth; like Louis himself, she has been willing to try new paths to reach her goals. In doing so, she has provided families, people with visual impairments, and colleagues with a model of what can be accomplished with persistence and strength. Best wishes to Susan for an adventurous retirement that never takes her too far from the professional community that greatly values her exemplary contributions. ***Advertisement AER Regional Conference Featuring COMA’s O&M Conference Within a Conference November 13-15, 2009-05-18 Crowne Plaza Cleveland City Centre Cleveland, OH USA Opportunity Rocks in Cleveland The AER Regional Conference is back! Join AER for the 2009 event in Cleveland, Ohio. 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