Orientation

Talk of walking leads naturally to orientation and we’ll touch on it in one form or another as we move through the various modalities of adaptation. To my mind, and best suited to my own abilities at this time, the cognitive concept of pattern recognition is of key importance to orientation. The effectiveness with which you use pattern recognition will depend on several factors with one of the most important being memory, specifically semantic (procedural) memory and working memory (Like RAM in a computer. How much can you hold in your conscious awareness from moment to moment?). This can also be thought of in terms of attention. Our capacity to direct, focus or spread our attention is a basic human cognitive attribute. But remember, attention is a limited resource. We all know this in one sense or another. There is a direct, if not perfectly linear and proportional, relationship between the resource of attention and performance at any given task. This concept may be summed up by the question, “Can you walk and chew gum at the same time?” Or it can be represented by the challenge to rub your head and pat your belly at the same time.

In psychophysical terms attention, like most things psychophysical, is measured in timed performance. In other words, how long does it take to process X stimuli under Y conditions? It is not merely the ability to direct a resource but exclude some stimuli from conscious awareness. You know the limitations of this facility when the kids are screaming while you’re trying to watch a particularly interesting news program. When you’ve reached the limits of your capacity to exclude ever growing distraction you tell the kids to knock it off and go to their rooms. The principles of concentration and exclusion are marvelously demonstrated in something called the Stroop Effect in which both concentration and interference are looked at in terms of reaction times. Follow these links to find out more about this fascinating effect. Dichotic listening

Suffice to say for now with regard to this limited resource that greater distraction leads to lower performance/higher reaction times. This can also be phrased thus: A greater facility for selective concentration leads to higher performance and, for someone whose life may depend on how he or she reacts to the environment, greater safety and less frustration. This is one of the reasons that procedural memory, in particular, is important here. As blind people we need to strike a balance between routine, automatic processes and an ever-changing environment. Many of us who have attended blind school will remember the strong admonishments against counting steps, particularly on stairs. We would rightly assume that we were given this in order to move our attention to the present and expect the unexpected, to use a rather worn out cliché. I’m not going to be this black and white here. It’s for you to decide what you can do comfortably, safely and automatically. If you’re physical environment is too chaotic to safely navigate on “auto-pilot,” (drawing from the subconscious and routine, procedural memory) then don’t. Use your cane and use the skills that you pick up here and elsewhere to keep yourself out of harm’s way. If it’s a ten foot trip to the bathroom or a cup of warm milk in the kitchen at 1am, be my guest provided that you know the cat won’t be waiting for you at the top step plotting your demise by an “accidental” fall down the stairs.

For now that’s as clear and solid a stand as I’ll take on whether or not to place your safety in the hands of your memory or counting or timing your way through your house, down the street or across town. You must decide what’s appropriate to your skills, memory and ability to quickly recover from mishaps.

So what’s the first thing that you do in the morning? Don’t skip anything. What’s waking up like for you? Is it a slow torturous process or is it something that happens fairly rapidly and without a lot of effort? What’s happening as you wake up? At the risk of getting caught up in the minutia, I want you to think about this because orientation is literally the first thing that you do every day. What mental faculty is it that brings you back to anchor every morning?

Most of us probably don’t come out of a night’s sleep into a state of disoriented alarm. We may wake up slowly with one or two senses “activating” at a time. You may feel your bed, your partner, your stiff neck or back. I have a coffee maker with a timer so the first smell of any significance for me is that of coffee brewing. If I’ve been on the sofa because I’m sleeping lightly and don’t want to keep my wife awake, it’s a 240 pound Mastiff farting in his sleep in his little corner of the room and then the coffee. Hearing will come in here somewhere. Again, if it’s the couch for me it’s the snoring from the aforementioned corner. The hearing may come in chunks and still be a little mixed up with what we’ve been dreaming but you soon have a handle on the distinction. This may be when you begin to open your eyes. If you’re totally blind you likely still open your eyes and your senses may still activate in much the same way as described above. I still have enough eyesight to be awakened when the light comes on over our bed or the curtains are flung open onto a sunny day. You likely already know where your head and feet are in relation to the bed and the room. This tells you with a minimum of eyesight where you are in the room, on the floor, in the house. It tells you where the bathroom is. You sit up in the dark or the half-light of predawn that is filtering through the closed curtains. There’s a good chance that you can’t see a thing but you know where your feet are in relation to the floor. If you’ve had a lifetime of experience with sight, as I have, you’ll start to form images of the important parts of the room that come together with the very limited visual cues. My side of the bed is nearest the door. We leave the door open when we don’t have company but it hangs at an angle to the wall due to the pegs attached to the back. I slip down the four or five inches (We have a very high bed with a very thick mattress.) and find myself pulling my weight over my feet and turning my head to the left slightly to orient myself toward the door. I can’t see a thing. I turn about forty-five degrees, take a half step and I have the edge of the door. I can feel the heavy over shirt that’s hanging on the outside edge brush against my knuckles. I complete the turn, walk down the length of the bed, turn ninety degrees to my right and can see the glow of our neighbor’s porch light filtering through the frosted glass of the double-hung window situated over our big claw-foot tub. I can’t see the tub but I know that situated to the left and about one foot closer is the toilet that I’m going to make my way toward.

As I walk out the bedroom door I know that there is a flight of stairs that begins less than one foot to my left. Turning my head to the left I can make out the very faint light that is splashing through the stairwell window from the streetlight outside. If I turn my head just a little it’s gone; a little more back again and gone again. I have only small islands of vision and light sources like this, like objects in the fully lit world, can seem to simply blink in and out of existence. Yes, I find myself more frequently surprised than the regular sighted person, I think. The bathroom door is just a few feet in front of me. I don’t know how many steps it is nor how long it takes to traverse this distance in the dark. My orientation to it is so thoroughly ingrained that I simply know when to put my hand up to verify the presence of the door jamb. I know the feel of the cool porcelain on my leg a moment later as I move past the sink, never touching it. I am very adept as a blind person but even I don’t pee from a standing position in the dark. But I do know exactly how far to turn in order to sit squarely on the toilet seat.

I’ll spare you more toilet details and move out to the hallway landing. Coming out of the bathroom to the stairs is a different matter than simply getting to the bathroom from the bedroom. More recently I’ve begun to notice that as my eyesight deteriorates I’m missing some of those little visual signals that used to come from the stairwell window more easily. It’s harder to know exactly where I am. What makes this worse is that unless I’m marching and making turns at perfect right-angles I have to go at the stairs from an oblique angle. By now I may or may not have my slippers on and I stop briefly in the bathroom doorway. I’ll pretend for a moment that I’m just not getting anything of value from the stairwell in the way of visual landmarks. I know that I’m going to cut across the landing at about a forty-five degree angle and in what I can perhaps only describe in terms of breaths (I’m slightly anxious, breathing a little more deeply now.) the inside ball of my right foot finds the edge of the first step at about the same time my left hand finds the makeshift rail. I count these steps all of the time, but at this time of the morning my counting faculties are simply not up to speed. I know the three steps down to the first landing and the left-hand turn down the rest of the steps but I’m almost certainly bound to lose track of the next twelve steps about three-quarters of the way down.

You’re hopefully getting a clear picture of what’s going on here. Indeed, you might be saying, “Big deal, I do that every day.” What I want to emphasize is that it’s important to move through this mental exercise systematically. As the landscape becomes more complex I’m less secure in navigating by memory, especially when I’m still half asleep. Most of the way down the stairs I’m grabbing a number out of the air – “Uh, that must have been eleven.” – and placing my feet quite carefully. The oak of the main floor feels different than the fir of the upper floor and the over-finished mystery wood of the steps themselves. It’s smoother, for one thing. What happens next is why it’s very important for everything to be moved back to its original position after a good house-cleaning. The track through the living room is like a little piece of Laguna Seca. There are four turns and a dog bed to get by before ever getting to the dining room. As for that, I’m still adjusting to the move from a five-foot to a seven-foot table that’s six inches wider. My memory is still stubbornly taking me into the corner of the table and into collisions with the different feeling chairs (though they’re softer upholstered chairs and not the hard oak that they once were.). The turn into the kitchen is easy provided that I don’t overcompensate for the wider table and again brush the battered Georgia O’Keefe print off of the wall again. Here I’m within one minute of my coffee and I’m feeling pretty secure. But even this first orientation can be thought of as a challenge.

The Basics: Standing and moving

Stand up. You may be at a desk just now reading this. You may be lying on your bed with your notebook laying across your abdomen. Maybe you’re at the kitchen table hunched over a keyboard squinting at these words. Fine. Read the next few paragraphs and stand up. I don’t know what you have on your feet so I’ll leave it to you to decide whether or not it’s appropriate to what we’re about to do. Move your feet around at the ankles and flex the toes. There’s a good chance that you’ve been sitting immobile for a while as you read. Perhaps your feet are even asleep. Wake them up. Move them around and get a sense of what it’s like to have feet that are attached to your legs. Point your toes down and pull them back up. Rotate your feet on their ankles clockwise and counter-clockwise. Feel how sensitive the arches of your feet are, how solid the heel and “balls.” Get up and put your feet under you. Make it an easy stance – comfortable with your weight distributed equally over each foot. Plant your feet about shoulder width apart and point your toes more or less forward. There is a good chance that your feet tend toward pronation or suppination. If your feet are pronate the inner ankles tend to turn down and inward and your weight tends to rest on two points, the inside of the heel and the inner ball of the feet. If you suppinate in your stance just the opposite occurs – your weight tends to come down over the outer ankle pushing down or “rolling” (as in a sprained, or “rolled” ankle) over the outer edges of the feet. Most of your weight will be distributed across the narrow knife’s edge of the outer foot, the outer ball of each foot and the outer heel. Depending on whether or not you tend to stand pigeon toed or with feet straight this can vary from front to back. Some of us additionally tend to move our weight forward or back. There may be more weight on the toes than on the heels. The reverse of this is less stable – moving the weight onto the relatively small heel are can easily destabilize even a standing position.

You’ve already moved your feet around a bit. You may have a good sense of how they feel under the weight of your body. You’re going to refine this sense just a little more now. If you think of your foot as a kind of tripod it may be a little easier to visualize what follows. You may have had enough sight or still have enough sight to remember what a bare footprint in the sand looks like. It’s the impression of an elongated tripod with a longish edge running from front to back between well rounded contact points. That’s an idealized footprint and assuming the footprint you’re looking at wasn’t made by a flat-footed person, it looks rather elegant and strong. The heel and the balls of the feet are fully present. They’re not half formed and one does not seem to dominate the other. This footprint looks “right.” If you pronate roll your feet back out and imagine it representing this image. If you suppinate imagine bringing that outer ankle away from the floor and distributing your weight evenly across your foot. If you tend to rise onto your toes, come back to your heels and balance. Point your feet straight ahead of you. This will be harder and take some effort for those of us who are knock-kneed (like myself) or pigeon-toed. If you find yourself concentrating on how unnatural this position feels take a long, deep breath with an even longer exhale, supporting yourself on a wall or table if you need to, and come back to it. Don’t make it a chore.

The martial artists that I’ve know with the best footwork (and that means the greatest stability and balance) tend to adjust their stances in this way. Those with whom I’ve sparred tend to assume a natural “toes-forward” stance when not fighting. This, and an even distribution of weight across those four components of the feet enables them to respond quickly to necessary changes in position faster. Later we’ll talk about the idea of “grounding” through the feet. I don’t want you to be immovable. I want you to be stable in stillness and as you move.

Balance

You won’t adopt and maintain the position that I’ve outlined above forever. At some point you will either need to move or an outside force will move you. No, we’re not talking about walking yet, but we are getting to it. Try this exercise with a friend:

Stand in what you believe to be a steady, stable position. Feel free to use the recommendations from above or use the posture and foot position that tend to work for you. Your feet may be at shoulder width side-by-side. They may be placed one in front of the other with some lateral distance between them. You may tend to stand with your feet side-by-side with very little distance between them. Have your friend give you a good, hard shove – not so hard as to knock you down, but hard enough that you have to move your feet in order to keep from falling. You may be tempted to reach out for support. Resist that temptation through this simple exercise. If your partner has pushed you hard enough a lot of things will happen, but for now I want you to concentrate on what your feet are doing. Where have they moved to? You will likely be far askew of the position we just worked with above but you will likely have fallen into a position of balance. Your feet will tend to move naturally into a position that can recover the most balance quickest. You may not find this new position an ideal for milling about with your friends, but you will be on your feet and ready to move your feet again, more or less, for the next upset. Our feet will not move into any one, set position under these circumstances. Even the simplest human movement is incredibly complex, calling into play dozens of muscles. If you don’t believe me, stand on one foot and concentrate on what the muscles in your feet, legs, and back are doing. The point is that depending on the shove, your position, your reflexes, the way that mass is distributed in your body and perturbations like injuries or pain that causes you to favor a particular posture, you will never end in exactly the same position each time.[A1]

Still standing

If your feet are more or less normal you are going to feel the floor or the ground through that “tripod” described above. What does the surface beneath your feet feel like? You may feel little irregularities in the rug or the hardness of the bare floor. Your feet covered in stockings may feel warm while your bare feet may feel more acutely the chill of the floor or the grain of the wood that needs to be refinished. It may feel smooth and hard or soft and warm. You may feel the heavy weave under the shag and you may feel the little splinter that’s about to come loose from the floor that’s still in need of refinishing. If you’re in my house you may have become aware of the cold puddle of drool that your very large Mastiff just left. Your feet are incredibly sensitive and you may be or becoming aware not just of what you’re standing on but how your feet, hips, back and legs are responding to those sensations.

Close your eyes again and take a breath. What is happening in the arches of your feet right now? Your calves? Do you feel those small “stabilizer” muscles making tiny, almost constant adjustments? This is just standing in one spot with your body fine-tuning your position in response to breathing (Your center of gravity changes slightly as the chest expands and contracts.), head position (The body tends to follow the head. Ask any experienced sky-diver.), maladjustments in your back or other joints (There may be pain or just a sense of misalignment. Ask yourself why we stretch reflexively sometime?). The surface that you’re standing on may be uneven, causing one set of muscles to fatigue before another (Ask any rock climber who’s ever had one foot stuck in a crack or a single toe on a tiny ledge for an extended period of time while he was figuring out his route.). We’re also all simply asymmetrical in shape. Though the large skeletal muscles and stabilizers tend to operate as pairs, one set is usually stronger or more enduring than the other. The body also makes idiosyncratic adjustments to accommodate this fact. These adjustments may be seen in habitual or characteristic postures. For example, I have two ruptured thoracic disks that tend to leave me with a tired and spasming mid-back and neck. My characteristic or idiosyncratic adjustment is to hunch forward, especially when I’m sitting. I’ve done some horseback riding and my unevenly distributed weight in stirrups quickly reminds me that I’ve sprained my left ankle many times and tend to favor it. The result, if I’m not careful, is a quickly fatigued right calf and ankle.

Walking

You may use a cane as an aid to your mobility as I do. What’s the purpose of the cane? The cane allows you to “feel” your environment. If you have eyesight like mine, there will simply be no replacement for the cane. But, there are ways to supplement what the cane gives you in terms of a feel for your environment. Let’s go back again to what you can feel under your feet. Many of us will claim that the feet are largely insensate unless we’re standing still in our bare or stocking feet on a very obvious surface like a cobbled patio or lush shag carpeting. To some extent this is true, especially given that we tend to wear shoes and tend to concentrate more on where we’re going than where we are. This way of moving has occasionally given rise to minor disasters, with and without my cane. I’ve walked into plate glass office doors because of my focus on the elevator doors beyond them. I’ve strode into concrete lampposts at a brisk walk because I needed to make a bus. I’ve stumbled over low rock walls with cane in hand because of my desperation to get in before dark. All of these incidents have entailed blood loss in larger or smaller quantities – usually in the form of lacerations to my face. I walk fast when I’m confident of my environment and becoming immediately aware of what is under my feet instead of where I’m going is still a bit of a struggle for me. What this entails is some degree of faith that my largely normal brain will be able to hold my destination or next stop for me without my constant attending to it. What requires my greatest attention is where I’m at right now. This means not just knowing my physical location when it’s possible to do so but what is under my feet at any given moment. Am I on asphalt or concrete? Has the paved trail turned to gravel? Is this just lumpy grass or the root of a tree? Did I miss with my cane what my left foot is telling me is the edge between the sidewalk and the curb strip? Do I need to stop, take a breath, and reassess my position and orientation?

This is an important point and I’m going to spend some time on it. When you walk, as when you stand, stabilize your feet. Point your toes forward and bring yourself back, in as much as it’s possible, and bring your weight back over the dual tripods that are your feet. If balance is important in standing, it’s critical in walking. How often have you fallen when your footing is uncertain? Were they hard falls? Partially recovered falls? Long, stretching “trips” in which maybe a hand comes to rest and then immediately pushes off of the ground? Do you recall what your gait was like? Were you pigeon toed as you moved? Were you walking “tippy-toed” or did you have an even heel-to-toe stride that “rolled” your sensitive feet over the surface you were walking over? Your feet are a big deal in preventing or minimizing falls. Of at least equal importance is, well – everything else. If you have been sighted you will likely have seen blind people taking in their environments. This can happen in a variety of ways depending on the environment, what kind of stimuli the blind person is orienting himself to, the natural inclinations and idiosyncrasies of the blind person, and the confidence of the blind person to orient or navigate. We will have seen people with and without training in the use of a cane. We will see different cane techniques and we will see blind men and women moving at various paces depending on their perceived abilities, their real abilities and what the environment demands.

One of the most common things that we will see is the head-down attitude. My theory here is that this almost reflexive response to blindness brings “vision” or visual perception to bear on the feet, whether there is any useful vision there or not. This posture can have several effects: 1) It may indeed bring some awareness to the feet and what the feet are standing on but, like a car with its headlights adjusted too close in, it leaves little time to respond to what the ground is bringing even when there is a bit of useable sight; 2) It changes our center of gravity, orienting our mass forward (Remember the skydiver and the body following the head.). The shoulders follow the head, the chest follows the shoulders and the hips follow the chest. A trip with this kind of posture will likely result in a fall forward; 3) If there is some sight to work with this posture can result in disturbing and dangerous optical illusions. A head oriented toward the ground, particularly in fog or rain where there are fewer visual cues to orient by may give the illusion of greater height or distance to everything around us. It can take familiar and useful visual indicators out of what remains of a limited visual field.

It’s not uncommon to find in combination to the head down attitude a head turned slightly to one side or another, perhaps to present a dominant ear or favor a less dominant ear. The head, the eyes and the ears are closely tied to one another neurophysiologically. As I’ve pointed out before, we have a very sensitive “homing” system that moves our eyes quickly to the source of a given sound. As the neck follows the gaze, so too may the gaze follow the position of the head. This too is important for a variety of reasons: 1) Getting a balanced “view” of the environments that we navigate in means a balanced awareness of sensory input. If my head, eyes and ears are oriented to oncoming traffic on my left before crossing a street there’s a better chance that I’m going to miss the bicyclist coming up on my right. This doesn’t mean that you should keep your head at a rigid “eyes forward” orientation constantly. It means scan, be still, scan again and don’t rely on any one particular orientation when moving through a potentially dangerous environment; 2) Again, as gaze follows head position be aware of what might happen in some of your other sensory systems. There is some evidence that indicates that as eye gaze moves into the periphery hearing “shuts off” momentarily. I’ve not personally been aware of this experience, but if it is a real phenomenon it falls into the category of reflex and it may be so thoroughly integrated into our cognitive and perceptual systems that it remains below the level of conscious awareness, like an eye blink shutting off vision for a fraction of a second. Have you ever had the experience of losing a large “chunk” of hearing as you yawn? This may be – probably is – an unrelated physiological phenomenon, but I use it as an example of how something as physiologically simple as a yawn or flick of gaze to the side can have a profound effect, if only for a moment, on an entire perceptual system; 3) We’ll talk about security at greater length later, but for now head down, shoulders hunched, particularly over a cane can mean vulnerable.

Simply put, a flexible and upright posture will give you the best opportunity to avoid and recover from falls and collisions. Head down with a limited field of vision not only unbalances, it will constrict a possibly already constricted visual field which can lead to vertigo. This is a very big problem moving down a flight of stairs. Falls can occur moving up stairs but tend to be less severe than taking a nose dive ass-over-teakettle down said stairs. Stairs are dangerous. For those like myself with severe constriction of visual field, loss of acuity and limited depth perception there can be moments of immobilizing confusion at an expanse of things that look like stairs but don’t register as stairs. The beginning of the aforementioned nose dive is not a time that any of us want to find ourselves frozen with confusion. If you need to, stop, take your time, examine with your cane if you can (this is particularly useful going up stairs) and get a mental handle on where you’re at by letting what senses you do have work in as efficient a way as possible. What do you hear? If you do have some eyesight, did the bobbing head in front of you just disappear or the person that the head belongs to seem to grow suddenly shorter? Where is the tip of your cane and do you feel an edge or a change in the surface under your feet (as with an escalator)? You can feel the surface under your feet with shoes on and I recommend shoes that are as light as the weather permits, yet supportive in a way that will enhance your good posture for a good long time if necessary. For me, this means a cross-trainer with good arch support (I have high arches.) that are sturdy yet have light flexible soles. These shoes should lace snuggly from bottom to top in order to provide a good sense of control and moderate rigidity from front to back.

Our attention tends to orient us laterally, not vertically, even when eyesight is seriously impaired (There is a lot of discussion of this principle in terms of saccades specific to reading.). This is normal, but it also means that we need to take the time to examine a vertically oriented environment and practice working out what is going on from top-to-bottom, not just side-to-side. In familiar, well-established landscapes you’ll have much of this worked out already. In landscapes that vary, for instance seasonally, this might mean lower hanging branches. I am constantly grumbling through the summers here in Oregon over the way trees and large shrubs are allowed to make incursions onto and over the sidewalks without careful attention to how low they hang in front of pedestrians. If you know that you are in an area in which something might strike you from overhead move slowly. Eye injuries, even to eyes that we may believe are largely useless, are serious and should be avoided (duh) when possible. If you are careful in this way you’ll likely save yourself a lot of wear and tear on your startle response, as well. Getting a stickery branch in the face is jarring at best.

I’ll review and expand a bit on a few points:

• Stand straight with as much of the weight over the feet as possible. Older men who have gained weight in their midsections may find this bit somewhat more challenging as not only has more mass been brought forward of the feet, the hips may tend to rotate into a more “bottom forward” orientation.
• Point the feet as straight forward as possible.
• As you move your tendency may be to lean forward past your feet. Pretend that you’re marching. When you see a drill team work a parade what you notice is little bobbing of the head and no leaning forward. Drill is hard because it requires some muscular control – control that most of us are unaccustomed to exercising.
• Don’t look down. Easier said than done for many of us. Practice and work out when you really need to look down at your feet. We’ll probably end up agreeing that it needs to be done far less than might have otherwise been guessed. As my first jumpmaster taught just before he pushed me out of an airplane, “You go the way your head is pointing.” If you look down, eventually you will go down. Your head will, again, pull your weight past your feet and you’ll find yourself off balance and in a bad position to take in your environment if you’re trying to get the most out of what eyesight you might have left.

Here’s a bit more of the muscular control bit: We let momentum do a lot of work for us. One of the things that you will here on a busy street if you’re listening is the dragging of feet. At best this is obnoxious. It also means that the walker is letting gravity and momentum do much of the work of walking for them. This is about not letting your feet fall to the pavement as you walk. You’re not going to goose-step, but you are going to pick your feet up just high enough to miss little obstructions like larger cracks in the sidewalk.

• The foot will come up under your body as you move forward. This will feel different in the thighs as you’ll feel them working to lift the foot and control its downward motion. The knees will not lock nor hyper extend keeping the legs pliable.
• The foot will first make contact with the ground on the heel as your weight is moving over it. This orientation of mass is especially important if you have to walk over ice. Too much forward momentum and the leading foot shoots forward. Too much leaning out over the front and the rear foot shoots backward.
• The heel does not strike the ground, it touches the ground and the foot rolls forward to the toes. With practice you’ll find that your sense of what is under your feet will improve.
• Here’s a piece taken from my own limited horsemanship skills: When cantering around a rectangular arena there is a preferred way to move through the corners called “getting on the right lead.” It means that at the corners where the horse must turn you are signaling him to get the inside forward leg in front of him. This stabilizes the rider and the horse in that the horse is not “falling over his shoulder” moving into the turn as he would if the inside forward foot were back behind him. In human terms getting on the right lead means that as you make a turn your inside foot is not behind you in mid-turn. If it is you are a) falling over the inside hip and gravity is pulling you down and forward, and b) at some point the outside foot must either come in very close to or cross the inside foot. Try this out as an exaggeration of what we may do naturally. If you pretend that you are on a motorcycle leaning into a turn you will feel this pull. Your staying upright is all about your forward momentum or what we former motorcycle racers call a gyroscopic effect. Brought back to walking the person who finds himself or herself stopped or slowed dramatically at mid-turn will fall down or, at best, stumble.
  

Modalities of adaptation

Travel – How do we get from point “A” to point “B?” Travel can entail a variety of sometimes tedious skills and factors. Here are a few:

• Navigation/orientation – What are the senses, skills and attitudes that we bring into play when stepping out to the grocery store or to a movie (Yes, blind people do go to the movies.)
  
• Planning/organization – Do your trips tend to be spur of the moment, once quick, hop in the car affairs that could be taken care of in half an hour? You may be finding now that travel is a much more involved affair, entailing bus passes, trip planning, knowledge of the environment that you intend to be in and preparation for long trips with water and an audio book. Include calculating how much grocery load that you can carry over “x” distance through “y” transfers with one hand on a cane and the other holding your Starbuck’s and you may find that you’re avoiding shopping altogether.
  
• “That little kid is staring at me” – You could hear him ask his mother on the bus line that you feel a hostage to ask her, “Why is that man carrying a cane?” He looks and looks and looks and you start to imagine (or detect) the furtive glances of others who assume that all blind people who use a cane are inevitably immersed in total darkness. The glances are furtive because they don’t want their travel companions to see them looking. You feel your face go hot as the kind but rough man grasps you less than gently by the arm to pull you into the seat next to him. Perhaps this is the daunting part for you that keeps you on as few buses as you can get away with without being a shut-in.
  
• Driving as an integral part of independence – There is a distinctly practical aspect to looking at aspects of our lives as sighted people that gave us meaning. Whether it was touring around the countryside all day visiting wineries or a simple hike at dusk, we are all more or less aware of our limitations but often unable to incorporate those limitations into our lives in a way that helps us maintain as much independence as possible without endangering ourselves or others. [Note: Consider navigation by comparing saccade behavior in both horizontal and vertical orientations. How might they be similar in scanning the environment? Different?]

Cooking and other “Activities of Daily Living” – How much is enough and how can I tell when my coffee cup is full? (aka: “Do you smell blood?” or “I bet you can’t guess how many times I’ve poured boiling water on my hand.”)

• Measurement
  
• Timing
  
• Cutting and peeling
  
• Cleaning
  
• Hygiene

Reading and listening – This is probably the most potentially wrenching bit for me. There is something about reading printed material out of a book, magazine or newspaper that is inexplicably and intrinsically gratifying. The last printed book that I took in was Cold Mountain in 1999 – Every morning on the bus to work in the crappy fluorescent glow of the bus’ back seats and later on the train across town. All print now is for reference and nearly everything else is audio or a combination of computer generated text and speech. Though we’ll talk about the emotional implications of making such adjustments, this bit is about the practical, so let’s take a short look at it before diving in.

• Why read? – Yes I said a “practical,” not “philosophical” look (at least for now). We’re not going to escape the need to read. Whether it’s a medication bottle or a movie description at the local Blockbuster, reading is a real and necessary part of everyday life. Besides, for many of us it’s simply gratifying.
  
• Size, lighting, contrast and color – What can we do to place ourselves in the best possible position to read when we need or want to? Some of us need magnification, though in my case I need to use discretion in order not to unduly magnify the dozens of little blind spots scattered throughout the remaining fiver or so degrees of my visual field.
  
• Reading position – Is it best to read on your back or upright in a chair? Lying on your stomach or on your side? Do you use a portable lap desk or pillows piled on your belly? Is it better to look ahead at your material or down at it? Basically, everything that can make you more comfortable while you read has the potential to extend your reading time, which brings us to the next…
  
• What’s your stamina for printed or “displayed” material like? – Can you go longer reading from a monitor where the lighting and contrast on many web pages, for instance, are fairly consistent, or is strongly lit printed material more your preference for sheer endurance? Some of us have to read a lot and it pays to look at some of the minutia of physical environment as well as attention and reading technique in order to optimize our reading.
  
• The technology of reading – Perhaps you’d be happy with one of the many CCTV’s on the market these days. You may be more oriented toward being able to look at and listen to your printed text at the same time, in which case any number of screen readers or “text-to-speech” engines might suit you.
  
• Listening to your reading – I first discovered audio books for long commutes when I was still driving and since have hardly been able to stand being without one running in my ear from day-to-day. Depending on how you get your audio, and depending on what you prefer, selections may be limited or you may be stuck with abridgements. We’ll look at availability and the variety of ways that you can bring reading in audio into your life.
  

More subtle yet still important modalities of adaptation include communication and social adjustment. We’ll look at these on their own, along with the emotional component of loss of vision.

Some of my experience of visioin loss

Some of my experience of vision loss

I have been counseled in a way by other counselors that tells me that I’m grieving. I’m a counselor myself and I find it hard to get my mind around this notion of grief within this context. Some counselors and psychologists might suggest that it’s a lack of sophistication in my understanding of the stages of grief. But, as a good counselor, I know that there has been great effort exerted to force the square peg of misery into the round hole of Kubler-Ross’s stages. Maybe it’s grief, but more likely, I think, it’s been despair that bites at my heels.

I barely remember those nights that could be lit up by a full moon; the shimmer and the colors. I’m from the Phoenix area and recently visited from my home in the Northwest. Upon returning my wife and I had dinner with close friends. They had been together for 2 years and while I’ve known Paul for 17 years, I’d only known Cristin for a few months. She commented innocently that, “The stars must be amazing there.” My high school dream had been to be an astronomer but by the end of my junior year I was already having difficulty seeing the stars. I faltered a bit then told her that I actually hadn’t seen them in years. She was abashed, but she shouldn’t have been. It was an innocent supposition that reflected her wonder at the world – and that’s a very nice thing to see in your friends. But I still miss the stars and all of the meaning that they held for me.

I miss the twilight, now, apart from the night, the most physically dangerous time for me. In my early transition into loss of vision it was the time that I was adapted neither to full daylight or full dark. Many sighted people find this true, as well. Carlos Castaneda held Don Juan Matas as saying that twilight and that time just before sunup are times of power. He was right, I think, but I seldom see them outside of photographs or within easy reach of a well lit piece of flat ground. As blind people, there is much that we took for granted as sighted that is now relegated to distant memory or the imagination.

Mostly, for me anyway, vision was very much about reading and this is what actually frightens me most about my loss of vision. While loss of independence sometimes inspires outright rage in me, I could go the rest of my life without ever seeing the Louvre and not feel terrible loss. The loss of my ability to read, on the other hand, terrifies me. Maybe because it’s more about who I am. Only 8 years ago, I was never without a book. Even working on my undergraduate and graduate degrees there were books that had little or nothing to do with what I was studying from day to day. Or better put, I studied nearly everything. There were few things beyond my sphere of interests. This was particularly true of psychology, religion and spirituality. Though I spent all night out partying at times, it was far more common for me to stay up all night with a book. The part of my life from which reading has been taken – is being taken – is the part that feels the thing most akin to betrayal and true loss. It’s relatively easy to let myself go at times and fly into little fits at my benefactors over my loss of independence and sometimes just for a moment to personify that betrayal with their lack of cooperation. The loss of the ability to read, however, the apparent loss of my ability to envelop everything with my mind cannot easily be laid at the feet of any person or group of people. If I were a religious man it would be God that I blamed and, like Job, might find myself curling up and wishing to die.

What I sense in myself now, apart from that loss, are actual cognitive changes. The way that I assimilate information is different, perhaps impaired. On the other hand, focused and systematic effort applied to the faculty of listening, mostly in the form of audio books, may have enhanced other parts of my verbal acuity – in the way that I assimilate information (encode), recall information (decode), and present that information verbally or in written form.

While, as I’ve already mentioned, my loss of vision has overtaken much of my ability to adapt to that loss the process has changed the way that I see my environment. The following is a correspondence between myself and a close friend. We spend a lot of time talking about consciousness and various mental and spiritual states. This day we had been talking about what he refers to as “Clarity” and memory, among other things:

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“In this time was something that I had taken for granted that now I feel might connect appropriately to this verbal memory. While symbols, particularly visualized written symbols are a beginning point to accessing verbal memory, I think that I’d describe them more as a mnemonic that I simply happened across. They spur conversational memory but don’t comprise it. I don’t read off of a ticker tape in my head. Conversational or verbal memory is more integrated than that and, as I said, less represented or inferred. The other piece to this only began to become obvious as I started to lose large chunks of visual field – you know, you don’t miss it until it’s gone. I found that I was becoming lost in simple situations and the need to make an adjustment became more clear. Where my eyesight began to fail to inform me spatially, I began to probe at the resources behind eyesight that were specific to orientation. I did this fairly systematically and by the time I reached blind school in 1998 I could orient myself better than most of the instructors. The most valuable orientation skill that I picked up in blind school was specific cane technique. The underlying components, I think, can be summed up as follows:

• The ability to accurately map my environment – This was not an exclusively visual phenomenon though it did depend on using what little eyesight I eventually had combined with my sense of hearing and my sense of timing (or timed distance, as it’s sometimes referred to). The hearing bit is interesting because I had lost some in the higher frequency ranges (anyone who works around jets in the military has a hearing test on discharge) and I still have some tinnitus. I worked in close proximity to jets for six years and it would stand to reason that I might lose some hearing. [Interestingly of late, there has been some research indicating that tinnitus might be a result of cross-modal neural plasticity. Put more simply rewiring of certain parts of the brain responsible for sight in a way that might enhance hearing.]
  
• Blind people are sometimes known to use an “echo location” or “radar” sense in orienting themselves. While I believe that I use this in a crude way I have more of an affinity for simply paying attention (I can tell by what I’ve interpreted as a “quality of silence” (not traffic noise, though that’s useful) when I’m at an intersection in a quiet residential neighborhood). This paying attention brings me to pattern recognition. Again, an area that I excelled at in blind school specific to orientation. I could navigate to an assigned (yet familiar) store based on what I saw of the corner of a sign. One of my sighted instructors (I did a lot of blindfold work with them) remarked that she had no idea the printer in the office made any kind of noise at all. Thus the pattern: approximate known printer location + small noise from cooling fan + conversation from the location in question + a timed sense of my location in a building = I am outside the office…pattern recognition aimed at orientation. My place on foot on a campus (holding a visual mental map), my location while riding on a bus (number of right and left turns), my position on a street (perceiving not merely a particular set of sounds but what I had come to think of as a “quality of silence”) add to patterns in a much broader sense than what you would see represented in any type of cognition textbook and are all important to me in their extensive varieties.
  
  One of these bulleted points could be seen as a sub-set of the other, but I prefer to look at them as distinct pieces. I would add to this “mapping” phenomenon that it is relevant not only for navigation but as an aid in finding, requiring more systematic attention to the map.
  

With an integration of senses (what includes what has been referred to as “a poverty” of visual information [I have yet to “refind” this piece of research that came out of the UK.], hearing, tactile sense (feeling what’s under my feet or hands and, under some circumstances, the feel of an individual’s body heat), hearing and even smell there is not one type of sensation that cannot be seen in terms of the others. Thus, what I perceive as a lack of emotional congruence in the type of memory that I’ve described. Sensation ties very closely to memory and this does not mean that I remember better because of a particular type of stimuli but that I am less likely to fail to remember because of a particular type of stimuli (or, more accurately, conscious or unconscious memory of a sensory situation with a strong emotional connection.). This is not to infer that all failure of memory can be tied to emotional/sensory congruence issues. That is just one component of memory encoding or access.

Remember, all of this is my interpretation of my experience over 30 years. Much of this interpretation I could do only very crudely early on. Much of it was not likely to have occurred until I had the impetus with loss of vision going into my 20’s and beyond.”

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Alright, so we’re psychology guys and bound to bore the pants off of most of you at least some of the time. And many of you may be wondering at what this has to do with the title of this section, “What does it mean to see?” Put very simply, many of us do still see, both in the literal sense and in terms of how we process our worlds in our minds. So here’s the rub: Much of the adaptation that I managed was a product of denial – my desire to stay well-adjusted and not obviously blind. That’s not a formula that I’d recommend to anyone else. So how do we go about passing on not just physical skills but psychological skills while maintaining a hold on our self-acceptance as blind people? Simply thinking about how we stand is as good a place as any to start.

A few words about adaptation

I’ve found it useful to break adaptation down in a couple of different ways. More broadly we can say that adaptation to blindness can be categorized as follows:

• Physical adaptation – What we do “in the world” to adapt to our environments
• Cognitive adaptation – How we think and perceive around the idea of adaptation
• Emotional adaptation – How we feel about blindness, adaptation and the circumstances that comprise them
  
  

Each of these types of adaptation will overlap in some way or another. For instance, the physical and cognitive aspects of adaptation intersect in navigation with a cane. The physical use of the can must be coupled with the learned skill in order for it to become an effective aid. Likewise, if there is great anxiety in leaving your home using a cane becomes problematic. These three spheres of adaptation could be said to represent the will, the skill and the means to adapt. There is an important point to be made here. Those of us who are totally blind, or nearly so, serve as living examples of the idea of need as motivator by developing adaptive skills that often surpass our own. Or, as Fred Williamson’s character says in “From Dusk Till Dawn” when he’s talking about “Nam”: “You'll take it 'cause ya got no choice.” This is adaptation born of need.

For the blind, as well as those others of us who are sensory deprived, adaptation can also be broken down roughly according to our senses:

• Sight – Let’s face it, for many of us sight is still our primary sense, if not in terms of everyday use and efficacy, in the way we think.
• Hearing – Usually taken for granted and not naturally attended to in the same way that eyesight is. There is some exciting anecdotal evidence that suggest that some blind people use a form of echolocation in their day-to-day activities.
• Touch – Not merely what you can feel with your fingers. What does the ground feel like under your feet?
• Smell – How close am I standing to that dumpster?
• Taste – Well, I’m at a loss here. I can only recommend that you refrain from putting very many things in your mouth that your sense of smell hasn’t already informed you are edible.
• Vestibular – Technically, it’s about the orientation of the head based on information gained from the inner ear. More broadly and practically, it can tell you about your general orientation in space and how you are moving through space, i.e., which way is up, which way is down and accelleration. Vertigo which can occur with a constriction or fragmentation of visual field is the disruption of this sense. Along with other mechanisms (For instance, structures in the brain that direct movement of the eyes to targeted sounds), the vestibular sense automatically coordinates the movement of the eyes and the movement of the eyes can affect whether or not hearing is “turned on.”
• Kinesthetic – Where is my right hand in relation to my nose? Put simply, the kinesthetic sense tells us, with surprising accuracy, where one part of the body is in relation to another.
  

Our examination of these aspects of adaptation will be, at least partly, anecdotal – my experience and, hopefully, yours as the site grows. There will also be a strong emphasis on the examination of research here. This research will include the psychophysical, computer models of human perception and cognition, case study and some looks at how the senses might interact, or even interfere, with one another. It’s my hope that this combination of experience and research will prove useful to those of you who have come looking for a reminder or a new spin on blind adaptation.

What does it mean to see?

Most of us might think that this question is hardly worth asking as the answers must be terribly obvious. But for those of us who have lost or are facing the loss of our eyesight the question takes on special meaning.

We are primarily visual creatures. Of all the creatures of the earth, from the blind to the gifted, our eyesight falls somewhere in the middle in terms of acuity, field of vision, color sensitivity, contrast discrimination and phase or pattern discrimination (Simplified, how do we detect edges, borders and lines on often chaotic backgrounds? How is the “line” at the edge of a table discerned from the “line” that separates two tiles on the floor?). Taken in context with the other senses such as hearing, the vestibular, and the kinesthetic, vision is crucial in everyday life. We can hear lower pitched noises than most dogs. Combine that with an ability to visually locate sounds approximately twelve times faster than a horse and considering that this must all occur in the context of how the head is oriented in space and we have the makings of an incredibly refined and sensitive system. We can see in “frequencies” above that of those that either cats or dogs can sense (Though their superior ability to sense lower frequency movement makes them look insane as they track and pounce on shadows that we cannot see.). Nearly the entire back or “occipital” portion of our brains to a depth of about 3 millimeters is dedicated specifically to vision – far larger than the proportions found in most other animals.

Human eyesight can be effectively divided into 3 component parts: 1)The optical, or that which occurs inside the eye, as in a telescope – the mechanics of vision, if you like, 2) the perceptual, or that which occurs in vision systematically, from the retina, the retinal ganglion, through the optic nerve and the central visual pathways of the brain to the visual cortex itself and, lastly 3) cognition, which is an extremely broad term but for our purposes can be thought of as a subset of visual perception that includes how we think about what we see and how visual phenomena such as optical illusions and “figure/ground” effects are interpreted.

Vision is a sense that we so take for granted that we seldom consider the practical or emotional components to it. It simply “is what it is” until something goes wrong with it. When something goes seriously wrong with our eyesight what it means to see comes to include our physical safety and our emotional well-being. For those not suffering with a serious visual impairment this may be difficult to get a handle on.

Vision is very much about our ability to navigate and accumulate information. It is about being able to drive yourself to work, see the highlights in your lover’s hair, find your keys, see a movie, read a book and appreciate art. It’s about being able to see the stars. It can be about being able to take that discreet, appreciative sidelong glance at someone you find attractive. It can be about being able to see that appreciative sidelong glance, as well. [A1]

The first thing that comes to mind with regard to physical safety is mobility and navigation. Some of us have continued to drive well beyond the point that we should have stopped, for our own sakes as well as for the sake of those that we’ve shared the road with. I stopped driving nearly ten years ago but only after several close calls with other cars as well as pedestrians. Navigation and orientation on foot may also become problematic. Still in that “in between” time of being sighted and being impaired but having already attended blind school I often exercised the option to navigate city streets and the insides of office buildings without my can. Though I’m still here to tell the tale, I’ve not escaped the exercise of that option unscathed