Chapter 3
Natalie Barraga and Visual Efficiency
Visual efficiency is one of the primary responsibilities of teachers of students with visual impairments. This was not always true. In 1964, Dr. Natalie Barraga’s book, Increased Visual Behavior in Low Vision Children, based on her doctoral research, profoundly changed the education of students with visual impairments. Her evidence showed that students with low vision—in two residential schools for the blind—whose educational strategies were primarily tactual could do two things:
- Match shapes, pictures, designs, letters, and words presented in black ink on white paper
- Improve performance on these tasks after instruction
One of the most significant findings in the study was that visual performance on these tasks was not highly related to measured acuities. Clearly, a new standard to determine what kinds of sensory strategies should be used in the education of children with low vision was needed. The field of visual impairments responded by establishing a practice of providing comprehensive visual evaluations. No longer does a medical eye specialist’s examination provide the only information upon which to base educational decisions. Now, TVIs plan individualized education programs and contribute to family service plans based on information from eye medical reports, functional vision evaluations, learning media assessments, clinical low vision evaluations, and orientation and mobility evaluations. Dr. Barraga’s pioneering work on behalf of children with low vision set this process in motion.
Perspectives on increasing visual efficiency
“Whereas vision can facilitate learning, learning can help to facilitate the use of vision” (Corn, De Priest, & Erin, 2000, p. 465).
In 1970, the American Printing House for the Blind published Barraga’s Visual Efficiency Scale and teacher’s guide. Ten years later, in 1980, APH published the Program to Develop Efficiency in Visual Functioning by Barraga and Morris. The theoretical model for these materials assumed that “children who have low vision develop visual skills in relatively the same order as do children with typical vision, although perhaps at a different pace” (Corn & Lusk, 2010, p. 13). Barraga’s work has been carried forward in the field of visual impairments in journal articles and books that examine and extend the fundamental principles of visual efficiency that she proposed. In 1983, Corn expanded on the developmental model by proposing that visual functioning is determined by three interacting dimensions: visual abilities, environmental cues, and stored and available individuality. Stored and available individuality includes the individual’s past experiences, cognitive abilities, sensory functioning, and psychological and physical characteristics (Corn & Lusk, 2010). In 1989, Hall and Bailey presented a model for increasing the use of vision that proposed the selective use of three methods: environmental management, visual skills training, and visually-dependent task training (Lueck, 2004). In 2010, Ferrell contributed a model, Key to Developmental Stages, that consists of nine visual developmental progressions “that can be used as a framework for guiding intervention to facilitate visual development in children with low vision” (p. 314). Each progression describes a range of responses on a continuum starting with the most basic response and leading up to the highest-level response.
Fortunately, current leaders in the field of visual impairments who have written on the subject are in general agreement about some of the key elements of visual efficiency instruction. In accordance with the mandate to use evidence-based, highly effective strategies, they describe interventions that have the strongest basis in research and acknowledge that more research is needed. In current literature, the foundation for best practice in providing visual efficiency instruction for students with ocular impairments is found in two primary resources. They are Functional Vision: A Practitioner’s Guide to Evaluation and Intervention edited by Amanda Hall Lueck (2004) and the second edition of Foundations of Low Vision: Clinical and Functional Perspectives edited by Anne Corn and Jane Erin (2010). These sources are the basis for the content of the three components in the Barraga Visual Efficiency Program.
There is strong consensus among the authors who contributed to the above sources on two major points related to visual efficiency.
- Visual efficiency is influenced by many factors including the following:
- Personal attributes (age of onset, self concept, experience)
- Visual attributes (type of visual impairment, severity of visual impairment)
- Cognitive, psychological, and physical attributes
- Presence of additional impairments
- Expectations of family members, other children, teachers, and eye care specialists
- Availability of frequent experiences that require the use of vision
- Availability of instruction
- Visual efficiency can be improved in the following ways:
- Conducting comprehensive evaluations to establish capacities and needs
- Using the learner’s evaluation of the usefulness of a visual strategy as the basis for selecting visual skills for instruction
- Providing instruction using different strategies so that students beginning to work on self-determination skills can select the strategy most efficient for them as tasks and environments change
These authors also agree that students should not be given the message that visual strategies are better than other types of sensory strategies. Corn, De Priest, and Erin (2000) ask teachers to consider the following points:
- After visual strategies have been taught so that choices are informed, professionals need to respect a student’s decision to use non-visual strategies because they require less effort or because they are preferred for any reason.
- Professionals need to affirm the validity and value of non-visual approaches or combined sensory approaches.
These fundamentals form the basis for answers to questions about evaluation and instruction in the following sections.
- Who needs visual efficiency evaluation and instruction?
- What do I need to know before I start?
- What intervention methods improve visual efficiency?
- What skills do I instruct?
- What is the best way to instruct?
Principle of Neutrality Regarding Use of Vision
One of the most important principles to remember when conducting any functional vision evaluation and during visual efficiency training is that the teacher of students with visual impairments (or certified orientation and mobility specialist), as well as any other team members involved with these processes, should always remain neutral in both word choice and voice tone in any responses provided to a student. Being able to use one’s vision should never be tied to any type of judgment or evaluation as to whether the student is doing “better or not” by using his vision. Vision just “is,” and it should never be communicated that a student is doing “better” or “worse” because he is able or unable to use his vision to see something or in a more efficient manner.
It is not uncommon for vision professionals to “encourage” students to “try harder” when using their vision to see something. Phrases such as “good job” and “are you sure you can’t see that?” and “that is great how you used your vision to locate that” are subtly judgmental. Personal evaluative statements or voice tone related to the student’s efforts to use his vision may unknowingly or unintentionally impact the student’s self-esteem if, even though he is trying really hard, he is unable to perform what is expected of him. No one should be made to feel inadequate or inferior in any way just because his vision will not allow him to do a particular task or see a specific item.
The student typically is doing the best he can with the visual impairment he has. It is human nature for a person to want to use the senses he has that work for him. But if one’s vision does not do what is being asked, or does not do it efficiently, then that should be “okay” with no personal judgment involved. A professional can ask a student to do a visual task in a functional visual evaluation, Learning Media Assessment, or during a visual efficiency activity; but if the student is unable to do it, the response and message should always be a neutral one such as “Okay, that’s fine. Let’s try something else.”
This philosophy of neutrality does not mean that you, as a vision professional, cannot try to teach a student how to use his vision more effectively and efficiently (e.g., by using scanning or tracking skills). Students with low vision often need to be taught how to use their vision more efficiently. But if, after such instruction, it appears a student cannot perform a skill or task any better or frustration is observed, it may be important to move to non-visual skills that the student can use in a more efficient manner to perform a task. And if that occurs, there should never be a sense of “failure” because one’s vision did not prove to be the best sense to use for a given situation or task. Once again, neutrality is what is wanted—it is neither better nor worse to use a tactual strategy or an auditory strategy instead of a visual strategy for a particular student at a particular time for a particular purpose. It should be communicated that whichever strategy is preferred and more efficient to meet a specific need is the “best” one, and neither strategy is “better” than the other.