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Sunday, December 9, 2007

About People with Visual Disability and the Usefulness of Braille

I had the privilege to meet people with severe visual disability in a study I conducted to examine the brain regions involved in Braille reading by touch. I am interested in brain plasticity. That is, I am studying the brains ability to reorganize after a change in input from the sensory periphery, e.g. the loss of eye sight. With positron emission tomography and functional magnetic resonance imaging, brain regions can be visualized that are activated during the exposure to sensory stimuli or the execution of tasks. Recent studies report that regions in the occipital lobes of the cerebral cortex that are known to process visual information in sighted people become activated in people with severe visual disability reading Braille with their fingertips. My colleagues and I at Vanderbilt University embarked on a study with Braille readers to examine specifically the role that the loss of vision may play in the recruitment of “visual” cerebral cortex for the processing of touch information. The movie shows typical cortical activation in a Braille reader with visual disability. At the beginning and the end of the rotation, the brain regions processing touch are at the top and the activated areas in "visual" cortex are at the bottom.


We could not determine in what cortical area the loss of vision was necessary for the recruitment. We could not find sighted readers who read Braille with their fingertips as proficient as people with severe visual disability. Hence, we could not exclude that visual cortex was recruited merely in the process of learning to read Braille, regardless of the presence or the absence of input from the eyes.

However, intriguingly we identified a number of cortical regions known to be involved in the processing of language. Careful analyses of the cerebral activation may help shed a light on the fashion in which occipital cortex processes information detached from a specific sensory modality, providing deeper insight into the workings of the human mind. Ford Ebner and I recently described the findings of our study comprehensively in a chapter of a book entitled "Blindness and Brain Plasticity in Navigation and Object Perception."


The study was a great learning experience for me. I had not met people with disabilities personally before.
  • I was very impressed with the ease with which most coped with the challenges of daily life, e.g. crossing a street. Next time when you stand at the lights of a busy intersection, close your eyes and decide when to go. You will understand immediately what I am saying.
  • I met many professionals with college degrees raising families. I asked one youngster whose parents are both blind, how they could possibly manage to keep track of him and his siblings. I have trouble with mine and I can see. He answered flatly: “It has never been a problem. My parents always know where we are and what we are up to.”
  • People with disabilities possess great wisdom of life. I once walked down the sidewalk with a participant, returning from a study. We were joking around fueled by the elation that we had a good session. The scanner had worked and nothing else had failed that day. A young man came up. He looked sullen. He called out: “Excuse me! May I ask a question?” “Yes,” my friend replied. “I see you walking down the street a blind man. Yet, you seem happy and content. I can see. But I am depressed. I have got to take pills to get me through the day. There is no happiness in my life. Would you trade with me?” My friend answered: “Of course, I would rather see. But I learned to live without. Take a day at a time and make the best of it.”
  • I was impressed with the physical abilities of people with visual disability. Many actively pursue sports. There are skiing programs in Colorado like Foresight that take people with visual disability to the slopes on weekends. Small groups are assigned to sighted guides whom they follow down the trails. I am a passionate skier. When I heard of the program, I imagined something quaint. Not at all! I happened to meet a group once on a black diamond tackling the moguls at awesome clip. I still cannot fathom, how you acquire this level of skill. My performance drops considerably in the fog. I was so impressed!

Finally, I learned about the meaning of Braille. A stencil with Braille cells is as essential as a notebook. The software that translates text to voice is improving at rapid rate. All major operating systems offer assistive technologies these days. Doubt is cast on the necessity of Braille in the future. However, many professionals prefer to use electronic Braille displays to be able to read the output from their computer most expediently and efficiently. Unfortunately, the gadgets are expensive compared with the voice programs, and not every employer is willing to make the investment.

Another problem is printing or, more correctly put, embossing. When I carried out my study, we attempted to emboss consent forms in Braille. It was a very cumbersome process. The software we had was rudimentary at best. The printer was highly mechanical and slow. The Braille dots were embossed in thick paper with metal pins. The noise reminded me of a machine gun and was quite unnerving. The gadget was huge, unwieldy and too expensive for personal use. I do not blame the engineers. They came up with a solution that is solid and works. However, in our day and age there must be faster, quieter and more affordable ways to emboss Braille.

I can only encourage development. Apart from the fascinating question how our brain processes Braille, Braille is here to stay for practical reasons. Who wants to depend on a computer during a black out?

Addenda
  • Driving a Prius people with visual disability may have great difficulty in hearing you coming. Please be considerate (09/27/08)!
  • New touch screen technology promises useful assistive technologies for smart phones. In his article published on The New York Times site on Jan. 4, 2009, Miguel Helft describes the work of T.V. Raman on applications tailored for people with severe visual disability using google's Android smart phone operating system.

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