A Definition of Vision Rehabilitation Therapy
by Dr. Lynne Luxton, VisionAware Peer Advisor
The growth and development of the profession of rehabilitation teaching [Editor’s note: now known as vision rehabilitation therapy, or VRT] in many respects mirror the evolution of what we often call the “field of blindness.” Rehabilitation teachers emerged from a charity model of services in the 19th century as ‘home teachers” who provided instruction in reading scripture. Today they constitute a cadre of university-trained professionals who address the broad array of skills needed by individuals who are blind and visually impaired to live independently at home, to obtain employment, and to participate in community life.
As a discipline, rehabilitation teaching combines and applies the best principles of adaptive rehabilitation, adult education, and social work to the following broad areas: home management, personal management, communication and education, activities of daily living (ADL), leisure activities, and indoor orientation skills. Outdoor orientation and mobility (O&M) training is provided by an O&M specialist.
The demands of rehabilitation teaching often require these professionals to address broad rehabilitation goals and to identify and coordinate an array of community resources. In that challenge lies the joy and satisfaction of the profession. Moreover, rehabilitation teachers who work with older persons must address the very specific circumstances that older people face. For example, older persons who are blind or visually impaired experience other age-related health conditions, such as hearing loss, heart disease, and mobility impairments, at rates as least as great as the general population. Rehabilitation teachers must be prepared to deal with these circumstances, as well as the loss of vision.
Rehabilitation Teaching in Historical Perspective
Rehabilitation teaching evolved from the goodwill and concern of charitable organizations and church groups in the 19th century and the early part of the 20th century. Instruction focused on teaching newly blinded individuals to read religious materials. In England in the 1850s, Dr. William Moon, a blinded minister, developed a system of embossed type (Moon Type) that enabled blind people to read the Bible. In the United States, the Pennsylvania Home Teaching Society and Free Circulating Library for the Blind in Philadelphia was organized in 1892 by John Rhodes of the American Bible Society and William Moon. Training continued to emphasize the reading of religious materials.
The first rehabilitation teachers, most of whom were women who were blind, were called “home teachers.” In time, home teachers recognized the necessity of moving beyond instruction in reading the Scriptures to the broader areas of communication skills, daily living skills, and handicrafts. Virtually no formal training was available for these instructors, who assembled an array of adaptive techniques, hints, and “rules of thumb” that helped people who were visually impaired and blind to perform daily tasks.
Connecticut was the first state to fund home teaching in 1893. By 1926, 25 states had home teaching programs. In the 1920s and 1930s, efforts were made to professionalize the discipline, but it was not until after World War II that rehabilitation teaching developed as a profession. The world wars had a marked impact on rehabilitation; veterans who were blinded in the wars required rehabilitation.
Elizabeth Cosgrove’s (1961) book-length evaluation of rehabilitation was the turning point for the development of the profession. Her study stimulated the federal government to develop university training programs in rehabilitation teaching. In 1963, Dr. Ruth Kaarlela started the first master’s degree program in rehabilitation teaching at Western Michigan University in Kalamazoo. There are now training programs for [rehabilitation teaching/vision rehabilitation therapy] throughout the country. These programs train rehabilitation teachers to understand specialized learning and teaching methodologies, eye pathologies, low vision, the psychosocial aspects of vision loss, the principles of rehabilitation teaching, gerontology, multiple-disability issues, adaptive techniques for ADL, communication skills, and indoor orientation skills.
Excerpted from Chapter 11: Rehabilitation Teaching for Older Adults by John E. Crews and Lynne Luxton, pp. 233-253 in Vision and Aging: Crossroads for Service Delivery, Edited by Alberta L. Orr. Copyright © 1992 by American Foundation for the Blind. All rights reserved. Reprinted with permission.