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Reading Acquisition in
Pupils with Visual Impairments in Mainstream Education
Stockholm Institute of Education Press
Studies in Educational Sciences 20
^ 4
som för avläggande av filosofie doktorsexamen
vid Stockholms Universitet offentligen försvaras i Kyrksalen, Konradsberg, Lärarhögskolan i Stockholm, Gjörwellsgatan 16
fredagen den 17 september 1999 kl 10.00 av
Kerstin Fellenius
Institutionen för individ, omvärld och lärande Lärarhögskolan
S-100 26 Stockholm
Language: English, with a summary in Swedish
Abstract
K ey words: pupils, visual im pairm ent, reading acquisition, reading environm ent, braille display, cerebral visual im pairm ent
This thesis is based on five em pirical studies o f pupils with visual im pairm ents, their reading ability and processes o f reading acquisition w ithin the fram ew ork o f mainstream education in com prehensive schools.
The aim o f the thesis is to increase our understanding and knowledge o f reading acquisition in pupils with visual im pairm ents in m ainstream education. A further aim is to find factors, which influence reading acqui
sition from an individual, as w ell as an environm ental, perspective. D evelopm ental theories regarding the individuals’ possibilities to acquire an optim al developm ent in interaction w ith their environm ent offer a theoretical fram ew ork for the thesis.
D ifferent research designs, descriptive and explorative, have been used to fulfil the purpose. The studies have revealed a heterogeneous group o f readers w ith visual im pairments bearing in m ind functional visual ability, reading m edia (print and braille) and reading ability. As a result o f these studies, it was possible to divide the readers into three groups w ith regard to reading performance. A bout one quarter o f the population was average or high achievers, another quarter extrem ely low achievers, irrespective o f visual acuity, reading m edia or reading devices. In m ost cases, additional im pairm ents, intellectual im pairm ent or language prob
lems caused low achievement. The largest group, about h alf of the population, consisted o f readers who were able to read but demonstrated difficulties in other ways. Visual acuity and reading m edia varied greatly in this group. There were uncertain readers, readers w ith low reading rate but good comprehension, readers w ith less stam ina and readers who did not use their reading ability except for schoolwork. The pupils were well equipped with optical devices, lighting and special desks but seldom used the facilities for reading. In general, the pupils with visual im pairm ents read less com pared w ith their sighted peers. N or w ere they exposed to text in natural situations in society, w hich decrease their incidental reading training. Conse
quently, a large group of readers w ith visual im pairm ents need an adapted reading program in order to stim u
late reading from the start and to use their potential ability. Competence in the school and hom e environm ent is necessary fo r compensating lack o f training and preventing the visual im pairm ent being the reason for reading difficulties.
Reading disabilities due to biological factors w ere significant for a sm aller group. Visual im pairm ent as a reading handicap is, in this thesis, identified w hen a person, able to read, does not have access to the text in an appropriate reading m edium or format, reading and writing tools are m issing or reading m ust be per
form ed in a badly adapted environment. Increased know ledge and effective environm ental measures could reduce a reading handicap caused by a visual im pairm ent for a larger group o f children and young people.
Stockholm 1999 180 pages
ISBN 91-7656-455-X ISSN1400-478X
in M ainstream Education
S-100 74 Stockholm Sweden
Stockholm Institute of Education Press (HLS Förlag) P.O. Box 34103, S-100 26 Stockholm, Sweden
Orders: phone +46 8 737 56 62, fax +46 8 656 11 53, e-mail hls-forlag@lhs.se
© Kerstin Fellenius 1999
© HLS Förlag 1999
Illustrations: Göran Fellenius Photo title page: Jorge Obligado Cover: Eva Spångberg
Print: Elanders Graphic Systems, Gothenburg 1999 ISSN 1400-478X
ISBN 91-7656-455-X
Reading Acquisition in Pupils w ith Visual Impairments
in Mainstream Education
Stockholm Institute of Education Press (Special Education)
Stockholm Institute of Education
This thesis is based on five empirical studies of pupils with visual impairments, their reading ability and processes of reading acquisition within the framework of mainstream education in comprehensive schools.
The aim of the thesis is to increase our understanding and knowledge of reading acquisition in pupils with visual impairments in mainstream education. A further aim is to find factors, which influence reading acquisition from an individual, as well as an environmental perspective. Developmental theories regarding the individuals' possibilities to acquire an optimal development in interaction with their environment offer a theoretical framework for the thesis.
Different research designs, descriptive and explorative, have been used to fulfil the purpose. The studies have revealed a heterogeneous group of readers with visual impairments bearing in mind functional visual ability, reading media (print and braille) and reading ability. As a result of these studies, it was possible to divide the readers into three groups with regard to reading performance. About one quarter of the population was average or high achievers, another quarter extremely low achievers, irrespective of visual acuity, reading media or reading devices. In most cases, additional impairments, intellectual impairment or language problems caused low achievement. The largest group, about half of the population, consisted of readers who were able to read but demonstrated difficulties in other ways. Visual acuity and reading media varied greatly in this group. There were uncertain readers, readers with low reading rate but good comprehension, readers with less stamina and readers who did not use their reading ability except for schoolwork. The pupils were well equipped with optical devices, lighting and special desks but seldom used the facilities for reading. In general, the pupils with visual impairments read less compared with their sighted peers. Nor were they exposed to text in natural situations in society, which decrease their incidental reading training. Consequently, a large group of readers with visual impairments need an adapted reading program in order to stimulate reading from the start and to use their potential ability.
Competence in the school and home environment is necessary for compensating lack of training and preventing the visual impairment being the reason for reading difficulties.
Reading disabilities due to biological factors were significant for a smaller group.
Visual impairment as a reading handicap is, in this thesis, identified when a person, able to read, does not have access to the text in an appropriate reading medium or format, reading and writing tools are missing or reading must be performed in a badly adapted environment. Increased knowledge and effective environmental measures could reduce a reading handicap caused by a visual impairment for a larger group of children and young people.
Mats Myrberg, my scientific and academic supervisor, for inspiring me to choose the exciting way of research, for co-operation and sharing his deep knowledge in the field of reading research and for all encouragement on my way
Kerstin Stenberg, the Head of the Department of Special Education, for her understanding and support to make it possible to finish my writing
Jane Brodin, Siv Fischbein and Astrid Pettersson, the professors who reviewed the manuscript and gave me valuable comments
Ulla Ek and Lena Jacobson, my co-authors at TRC, for enriching my knowledge in the field of psychology and ophthalmology and for interesting interdisciplinary exchange
Birgitta Göthberg, the Swedish Handicap Institute (HI), and Marianne Svanheim, the National Board of Special Needs Education (SIH) for taking the initiatives of the developmental projects and the financing
Gunilla Stenberg Stuckey and Harry Svensson and the directional board at TRC for their generous support to produce the thesis
Barry Hampshire, my reliable translator
Anne-Marie Risberg and Örjan Bäckman, my nearest colleagues at the Institute of Education, for sharing my thoughts and giving encouraging support
All colleagues at TRC and SIH who have been involved in the different projects and contributed with their great knowledge and efforts.
And above all, my family
Göran, my beloved husband, for a never-ceasing interest and understanding during the whole research process, for patient listening and sensible comments, for all engagements in the technical production and drawings in the thesis
Lotta and Tina, our daughters, for their support and strengthening believe in their mother
Siv and Owe, my sister and brother, for their interests and engagements.
numerals I - V.
(I) Fellenius, K. (1996). Reading Competence o f Visually Impaired Pupils in Sweden. Journal o f Visual Impairment and Blindness, 90 (3), 237-246.
(II) Fellenius, K. (1999). Swedish 9-Year-Old Readers with Visual Impairments: A Heterogeneous Group. Journal o f Visual Impairment and Blindness, 93 (6), 370-380.
(III) Fellenius, K. (1999). Reading Environment at Home and at School o f Swedish Students with visual impairments. Journal o f Visual Impairment and Blindness, 93:(4), 211-224.
(IV) Fellenius, K. (1999). Computer based instruction fo r young braille readers in m ainstream education - an evaluation study.
M anuscript subm itted for publication.
(V) Fellenius, K. Ek, U. & Jacobson, L. (1999). Reading strategies in children with cerebral visual impairment.A pilot study o f four cases.
M anuscript submitted for publication.
at Tom teboda School Resource Centre (TRC), SPRIDA com puter resource centre and several low vision clinics. As a form er "teacher for the blind" in the 1960s at the special school, as educator at TRC and adviser for pupils w ith visual im pairm ents in ordinary schools in 1970s and 1980s, it has been an exciting w ork obtaining a picture of today's pupils w ith visual im pairm ents and their reading in m ainstream education. I have visited m any pupils and schools during these years, from Pajala in the n orth to M almö in the south and from w est to east. It has been a fantastic and exciting journey, sometimes in snow storm s, som etimes in the w arm ing spring sunshine. Even so, the m ost fantastic has been the w arm reception I have felt and the tolerance I have been m et w ith w hen I have "encroached on" pupils, parents and teachers w orking lives. W ithout you it w ould n o t have been possible to present this picture. It is m y hope that it w ill increase understanding of the situation you handle on a daily basis and so conscientiously m ake the best of. I hope as well that m y picture will increase the opportunities for you to obtain the right su p p o rt in the teaching and learning environm ent in the hom e and at school.
For financial su p p o rt I w ould like to thank the Stockholm Institute of Education, the N ational Agency for Education, the Swedish Council for Social Research, the Swedish M inistry of H ealth and Social Affairs, the N ational Agency for Special N eeds Education, the Swedish H andicap Institute, the Tom teboda School Resource Centre and the Foundation of Sven Jerring.
Stockholm in Septem ber 1999 Kerstin Fellenius
Educational prerequisites 7
H istory and current situation 7
From special school to inclusive education 10 M edical and educational investigations 13
Teacher training 15
N um ber of children and young people
w ith visual im pairm ents 16
Reading acquisition 17
Individual incentives 17
Social dem ands 18
Theoretical perspectives 19
Aims and research questions 24
The visual system and reading 25
The visual system 25
Visual functions 26
Functional vision (visual ability) 27
The reading process 30
Different perspectives 30
The reading process and visual im pairm ent 32
Teaching reading 38
Degree of visual im pairm ent and reading m edia 40 Blindness or profound low vision 40
Severe low vision 41
M oderate low vision 42
Assessment of reading ability 44
M ethodological and ethical considerations 46
Sampling 48
M ethods for data-collection 50
Individual prerequisites 50
Context and reading settings 51
Sum m ary of the studies 53
General findings 63
Individual capabilities/opportunities for
reading acquisition 63
Prerequisites in environm ental settings
for reading acquisition 64
General discussion 65
Concluding rem arks 78
Svensk sam m anfattning References
81 87
INTRODUCTION
Background
In Sweden today pupils w ith visual im pairm ents w ithout severe additional im pairm ents are taught in ordinary schools in their local district. This m eans that the regular teacher in the local authority's school has responsibility for the educational developm ent of these pupils in all subjects. A n im portant basis for acquiring know ledge, as w ell as supplying it, is the p rinted w ord. It falls, therefore, on the teacher to provide the pupils w ith the m eans for this
educational developm ent - the ability to read and write. Earlier, children w ith profound visual im pairm ent or blindness w ho w ould learn braille w ere taught in a special school, Tom teboda School in Solna. Tom teboda School w as
successively transform ed during the large-scale integration m ovem ent of the 1970s an d 1980s to a resource centre and, in 1986, the perm anent school section w as discontinued. The regular teacher, therefore, teaches even pupils w ith p rofound visual im pairm ent or blindness to read braille today. For pupils w ho are partially sighted and w ho, w ith optics an d low vision devices, m anage to w ork w ith ordinary teaching m aterials, there existed earlier som e special teaching groups - so-called "sight classes" - in Stockholm, G othenburg and Malmö. C urrently there are a few pupils left in "sight classes" in Stockholm w hich also include a few braille readers.
The teaching environm ent for pupils w ith visual im pairm ents has, thus, changed during recent decades. At the sam e time m odern technology offers new w ays of m aking text accessible and com m unicable for pupils w ith visual im pairm ents. The new possibilities, w hich the com puter opens as a reading and w riting device, are perhaps m ost dram atic and prom inent for braille readers. H ow ever, they are also opportunities for pupils w ith low vision to acquire better reading and w riting developm ent w ith text presented in a form at w hich is readable for h im /h e r. Technology and education m ust, therefore, m eet in the classroom in order to increase the opportunities for learning. A nother com petence is required in teaching pupils w ith visual
im pairm ents than the traditional kind from special school and "sight class"
era.
Earlier insights and know ledge have been deepened by studying the m any facetted relations betw een p upils' reading and w riting ability in relation to sighted classm ates' in the new learning environm ent. In project works, deeper know ledge about active processes in the classroom w here pupils w ith visual im pairm ents are taught have been achieved. The absence of a special school as an alternative teaching form for pupils w ith visual im pairm ents w ithout additional im pairm ents in a country is rather unique. The N ordic countries have been pioneers in this developm ent. The inclusive system also m eans that there is no special curriculum for pupils w ith visual im pairm ents in m ainstream education. The possibility exists, therefore, that a class teacher in an ordinary Swedish school can, during h is /h e r time of service have the task of teaching a p u p il w ith a visual im pairm ent w ithin the fram ew ork of the ordinary class and curriculum . This m akes studies of these pup ils' school successes even m ore interesting and urgent.
Scope o f the thesis
This thesis builds on five different studies of the reading ability of pupils w hen they have a visual im pairm ent. A m ain purpose has been to raise the level of know ledge about the pupils reading ability and p u t this in relation to reading environm ent and dem ands on reading in m ainstream education. In addition to this, factors that affect reading acquisition from individual, as well as environm ental perspectives have also been focused.
M easured visual acuity, w hich is generally one of the predictors w hen selecting reading m edium and reading devices w here visual im pairm ent is involved, constitutes an im portant basis for the divisions of reading categories in the analysis an d processing of the results in four articles (Paper I, II, III and V). The m edical background of the visual im pairm ent, the diagnosis of the pupils, has not been in focus for the processing of the results in m ore than one article (Paper V).
Reading an d w riting ability can usually be carried out together as they often go han d in h an d w hen learning to read. In English language literature
both concepts are gathered u n d er a single nam e - literacy - w hich also speaks for reading and w riting ability being closely related in a developm ent perspective. For pupils w ith visual im pairm ents, m ost research has traditionally focused only on reading ability. W hen o rdinary text is not available to the reader due to a visual im pairm ent, the problem is initially concentrated on finding alternative w ays of m aking it accessible. For example, enlarged text can be presented for those w ho have usable residual vision, or it can be converted to braille for those w ho are severely visually im paired. In the latter case, visual ability is no longer decisive w hen confronted w ith text. The m ethod of w riting is a direct consequence of the choice of reading m edium and reading device. The goal w ith w riting has, above all, been that the p upil w ith visual im pairm ent should be able to re-read his ow n text. Reading and w riting has, for example, w ith certain traditional w riting devices for braille, not been possible to carry out sim ultaneously, w hich could also explain the approach of earlier research on, above all, reading. H ow the w riting process functions together w ith the reading process d uring reading acquisition w hen visually im paired is still an area w here m ore research is needed. The
significance of w riting for reading developm ent has not been focused on or evaluated in the studies covered by this thesis either, b u t is discussed in tw o of them (IV and V) w hen it is closely associated w ith the pupils reading results.
New trends w ithin reading and w riting education, w here the significance of the w riting process for learning to read for sighted children is em phasised, have now also reached special teachers for ch ild re n /p u p ils w ith visual im pairm ents m ainly in A ustralia and the USA (Rex, Koenig, W ormsley &
Baker, 1994). Access to new technology as reading and w riting tools w ill m ake it possible to study the interaction of reading and w riting processes in reading acquisition for pupils w ith visual im pairm ents.
The fram ew ork of this thesis considers three areas of knowledge:
• the reading process and reading acquisition
• visual im pairm ent and reading
• educational conditions for pupils w ith visual im pairm ents.
After definitions of visual im pairm ent, an historical and current overview of the educational prerequisites w ill be presented as a background to the general purposes of the studies. The theoretical fram ew ork of reading acquisition in the thesis is presented in the following chapter before the overall aim and research questions are specified. The next chapter deals w ith the functions of the visual system and its relation to reading, followed by an overview of various theoretical perspectives of the reading process and how a visual im pairm ent can interfere w ith reading. Alternative reading m edia such as braille and the selection of other appropriate reading m edia and devices for different groups of individuals w ith visual im pairm ents, are then described.
The m ultiple m ethods used and m ethodological and ethical considerations are then discussed before the articles and general findings are sum m arised. The fram ew ork will be concluded w ith a general discussion about the three areas of know ledge m entioned above.
D efinitions o f visual im pairm ent
The definition of visual im pairm ent varies in the literature w ithin different scientific disciplines and in different countries. W ithin m edicine and
legislation the basis is often found in visual functions (visual acuity an d visual field) an d their m easurable values while educationalists usually use m ore qualitative definitions of visual ability (functional vision) as in the quote below:
"The general term visual impairment can refer to any condition in which eyesight cannot be corrected to what is considered "normal". In this book, the term is used to refer to a loss of vision that makes it difficult or impossible to complete daily tasks without specialised adaptations."
(H o lb ro o k , 1995, p . 2)
"The generic term visual impairment is used to describe the continuum of sight loss. Where a distinction is necessary, the term blind is used to describe children who rely predominantly on tactile methods in their learning while the term low vision is used with reference to children who are taught mainly through methods which rely on sight."
(M a so n & M cC all, 1997, p . XV)
A m ong ophthalm ologists it is also possible to find descriptions that use functional vision (visual ability) besides values m easured in tests of visual functions.
"An alternative functional definition favored by the authors is loss of vision sufficient to prevent one from being self-supporting in an occupation, making the individual dependent on other persons, agencies, or devices in order to live."
(Vaughan & Ashbury, 1980, p. 340).
The effect of the visual im pairm ent for the ad u lt's independence is
em phasised often in order that the person w ith visual im pairm ent should gain access to society's services in the form of rehabilitation an d technical devices.
Choice of device and assistance varies depending on the degree of visual im pairm ent. In Sweden, the rules regarding prescription of technical devices generally follow W H O 's definition in 1980 (WHO, 1994), w hich are based on visual acuity w ith the best correction and the size of visual field. The same rules are m ostly practised for children as for adults. Visual acuity is expressed w ith different num erical expressions depending on the system adopted in each country. In the N ordic countries a decim al system is used w here 1.0 is the expression for "norm al" visual acuity (the possibility of seeing better than
"norm al" exists). In Anglo-Saxon countries norm al visual acuity is expressed by 6 /6 . The num erator gives the distance in m etres at w hich the sym bol on the sight test board is read and the denom inator gives the distance at w hich a
"norm al" eye can read the sam e line (or 20/20 expressed in feet). Persons w ith visual im pairm ents are divided into three different categories according to W H O (1994), based on degree of im pairm ent: moderate, severe and profound visual impairment or blindness (Table 1).
In this thesis pupils w ith visual im pairm ents have been studied on the basis of these three categories in relation to reading m edium and w ay of reading. Pupils m entioned as having extrem ely low vision in Paper I are in the sam e group as p upils w ith severe low vision according to Table 1.
Table 1.
WHO terminology for visual impairment
Category of vision Degree of im pairm ent Best corrected visual acuity
Alternative definition
N orm al vision None
Slight
>0.8 (6/7.5; 20/25)
<0.8 N ear norm al
Low vision M oderate
Severe
<0.3 (6/18; 20/60)
<0.12 (6/48; 20/160)
M oderate low vision Severe low vision.
Counting fingers at 6m or less.
Blindness Profound <0.05 (3/60; 20/400) Profound low vision
or moderate blindness. Counting fingers at <3m N ear total <0.02 (1/60; 3/200) Severe or near total
blindness. Counting fingers at lm or less or hand m ovem ents at 5m or less
Total No light perception
(NLP)
Total blindness (including absence of the eye)
(Adjusted from Baird, G & Moore, A.T., 1993, p. 2).
Impairment - Disability - Handicap
The use of the concepts im pairm ent and disability are often m isleading. Both concepts refer to the individual.
Impairment is a disorder interfering w ith an organ function, a loss or abnorm ality of psychological, physiological or anatom ical structure or function, a bio-m edical status.
Disability is the lack, loss or reduction of an individual's ability to perform certain tasks. Disability reflects the consequences of the im pairm ent, the functional perform ance and activity b y the individual. (Faye, 1976; WHO, 1994).
Handicap, on the other hand, is a social phenom enon. H andicap represents the social and environm ental consequences for the individual stem m ing from the presence of im pairm ents and disabilities. It concerns w ith the disadvantages experienced by the individual in the interaction w ith the individual's surroundings (WHO, 1994).
EDUCATIONAL PREREQUISITES
H istory and current situation
Pupils with visual impairments only
The first step tow ards educating young blind people in Sw eden w as taken in 1807 w hen Pär A ron Borg taught a young girl at his hom e and the year after allow ed h er to take the public exams. H e then expanded his w ork to include teaching the deaf and, in 1809, he opened the Institute for the Deaf and Dum b and the Blind. The school w as financed partly by governm ent grant b u t also w ith funds from the general public. The Royal Family functioned as the Institute's patron. Up until 1817, the school educated ten blind pupils. After that the intake of blind pupils stopped com pletely until 1846 w hen they w ere once m ore taught together w ith the hearing im paired. A special institute for only blind pupils w as established first in 1878. Ten years later in 1888, the school could be m oved to its new building - the Royal Institute for the Blind - at Tomteboda. The first law regarding com pulsory education for blind children w as passed in 1896, just over fifty years after the school reform of general elem entary schools in Sw eden in 1842. Education at the Institute for the Blind w as now com pletely free from school fees.
Since the 1870s the w ritten language for the blind in Sweden h ad been Braille's alphabet m ade u p from patterns of dots, w hich w as used in parallel w ith an earlier system of raised characters - the M oon alphabet - based on raised lines and angles instead of dots. The pupils learnt, how ever, to w rite ordinary p rin t as well w ith an "ingenious technical device" (Gissler, 1964, the author's translation). In 1925 ordinary typew riting w as introduced into the timetable b u t otherw ise the new teaching plan, w hich h ad been in use in elem entary schools since 1919, w as used. As there w ere also partially sighted pupils at the school, special reading training of ordinary p rin t w as introduced for these pupils in 1932. In the sam e year a braille library w as established at the school.
A new curriculum for theoretical subjects w as introduced year 1954/55, w hen com pulsory school for blind children w as also extended to eleven years.
curriculum still m ore or less followed the one used in regular, com prehensive schools b u t new subjects such as dom estic science, m obility and long-cane technique w ere also introduced in order to ad a p t the pupils to a future independent life. D uring the 1960s, theoretically gifted children began to transfer m ore regularly to ordinary secondary schools after the theoretical eighth or ninth year at the Institute for the Blind. They w ere considered then to be able to cope w ith reading and w riting in braille by them selves and, w ith the help of an ordinary typew riter, perform their assignm ents. Their study m aterial in braille an d technical devices w ere obtained from a special library at the Institute for the Blind, founded in 1956. This w as converted to Tom teboda N ational Centre for Educational Devices for the visually im paired in 1965 and is the origin of the present state educational devices production - SIH-
Educational M aterials - w hich is lead today by the N ational Swedish Agency for Special Education (SIH).
Similarly, the origins of the state organisation for special educational advisers also h ad its origins in the Institute for the Blind. The first itinerant teachers for pupils w ho h ad left secondary school w ere created by the Institute for the Blind and w ere appointed in 1958. The organisation of the advisers is now incorporated w ithin SIH and consists of about 30 posts serving pupils attending com pulsory education.
The integration of pupils from special school to ordinary schools continued d uring the 1960s and 1970s at an ever-increasing rate while, at the same time, the perm anent school section of the Institute becam e smaller. In accordance w ith the new special school decree of 1965, the special school, w ith its new nam e "the Tom teboda School, special school for pupils w ith visual im pairm ent", now offered a 10-year com pulsory education. The new curriculum for the com pulsory school introduced in 1969 covered now the special school b u t w ith some additional areas e.g. sensory training, extra time for art and design, physical training and handicrafts at the prim ary level.
Consequently, pupils in special schools had m ore hours of classroom teaching per w eek than the corresponding classes in ordinary schools, as well as a tenth year at school.
Pupils with visual impairments and additional impairments
In 1886 "The School-Home for Blind and Deaf M utes" w as opened in Skara w ith the help of a State grant and m oney w hich h ad been collected from the general public. Thereby the ground w as laid for a teaching institution especially for the deaf and blind (Jarl, 1995). The State w as at its head w hen the w ork expanded an d in 1922 it m oved, w ith its 142 pupils, to "N ursing hom e in Lund for blind w ith com plicated defects". At the end of the 1950s, the dem and for places for m ultiple disabled w as so great that the need for a com pletely new school arose. In 1965 the n ew school, Ekeskolan, was inaugurated in Örebro. According to the special school decree, this school should also be a special school for the visually im paired w ith a 10-year
com pulsory education b u t m ainly for pupils w ith additional im pairm ents w ho could not be taught in ordinary schools or in special schools for m entally retarded. The m ost com m on additional im pairm ents were, and still are, m ental retardation, hearing im pairm ent a n d physical disability. D uring the school year 1997/98, the school h ad 43 pupils, 35 of w hom h ad an additional im pairm ent (SOU 1998:66). Besides the school there is also a resource centre (Ekeskolan's Resource Centre, ERC) w here investigations and training visits as well as external courses for the c h ild 's/p u p il's family and staff are carried out.
According to a recent proposal of the governm ent the perm anent school section w ill be discontinued in some years (Prop. 1998/99:105).
Pre-school
There have never been institutions for blind, pre-school children w ithout additional im pairm ents in Sweden. The insight about the im portance of getting into touch w ith the children and their parents before starting school existed, how ever, at the Institute for the Blind at Tom teboda. In 1952 the Institute introduced the service of a school nurse w ho visited families. The first state, special education adviser post w as established shortly afterw ards in
1954 and w as followed by a further tw o such posts un d er the m anagem ent of the Institute of the Blind. As well as hom e visits, the pre-school advisers arranged sum m er courses for parents in order to m ake the transfer from hom e to boarding school as sm ooth as possible (Gissler, 1964). The pre-school advisers also w orked to get the children adm itted into "ordinary nursery schools, day-care centres, rhythm and dance groups" (ibid., p. 28, the author's translation) in the area w here the child lived w ith successful results. The activities of the pre-school advisers expanded and in 1978 there w ere 9 posts w hich served about 500-600 pre-school children w ith visual im pairm ents and additional im pairm ents (Ds U 1979:11). This m eant that each family could receive a visit twice a year at the most. Today there is an adviser organisation for children w ith visual im pairm ents u n d er SIH that includes about 30 posts.
From special school to inclusive education
Special School
The num ber of pupils at the Institute for the Blind already began to reduce in the 1930s from over 200 pupils to about 130 pupils during the 1950s. Those pupils w ith low vision, or partially sighted as they w ere also called, and w ho could use ordinary print, h ad disappeared from the school. They w ere now taught in their local schools or in special low vision classes, w hich w ere established in 1956 in Stockholm and G othenburg and in M almö in 1959.
W hen, in 1965, Tom teboda School began the ten-year com pulsory education for the visually im paired, there w ere about 140 pupils. D uring the 1970s the num ber of pupils decreased rapidly and in the school year 1978/79 there w ere only 40 pupils registered as attending the special school. The age at w hich the pupils w ere integrated to the ordinary com prehensive school in the pup il's m unicipality h ad now become lower. The idea that the pupils should be able to cope w ith braille w ell by them selves before the step w as taken to ordinary classes still prevailed. An experienced teacher of the visually im paired, responsible for teaching braille, w as considered a pre-condition for beginners w hen the first potential braille reader started directly in the m unicipality in
1978. M any parents now began to dem and that their children should attend a local school in order to avoid placing them in a boarding school. Efforts w ere m ade to m eet these dem ands an d in 1986 there w ere only seven pupils left in the special school. The school section w as then discontinued and Tom teboda School h ad been converted into a resource centre (TRC).
Suggestions for support
As a consequence of the rapid integration of braille reading pupils, a need arose for further education in the local schools. In 1977 the N ational Board of Education appointed a w orking group - the Tom teboda G roup -w ith the task of proposing a new organisation in order to m aintain the resources and com petence that existed am ong the staff at Tomteboda. The Tom teboda group should also m ake proposals about the am ount of support, w hich should be provided for the m unicipalities. In order to give local m unicipality sufficient support, the group proposed that the num ber of advisers should be increased to 30 w ithin each area. This w as to ensure that "the integrated, pupils w ith visual im pairm ents should receive an equivalent standard of education as the sighted" (Ds U 1979:11, p. 29, the au th o r's translation). The group also proposed that the advisers for pre-school and itinerant teachers should w ork closely together in order to prepare the transfer from pre-school to school. An itinerant teacher w ho h ad a basic training as a junior schoolteacher should visit the braille beginner once a w eek during the first year. In classes at the junior level w here blind or pupils w ith p rofound low vision attended, there should also be a "com panion teacher" 13 hours p er w eek - an extra resource that should be assigned to the school from the G overnm ent according to the the g roup's proposal. The com panion teacher should have special teacher training and be responsible for the basic subjects - Swedish and m athem atics - and teach braille at junior level. The com panion teacher an d the class teacher should participate in the further education course arranged by the Resource C entre on three occasions, each lasting one week. W ith this organisation the p upil integrated in the ordinary class w ould not hold any exceptional position b u t instead become a m em ber of the group, according to the Tom teboda G roup (ibid.). In order to create an even fairer relationship for the pupils w ith
visual im pairm ents it w as proposed that costs for staff assistance and technical devices should be provided b y G overnm ent grants.
The adviser organisation
As a consequence of integration of disabled people in society in general, principles of proxim ity to, and availability of, com petent su p p o rt for the disabled person w as discussed w ithin the area of handicap politics in Sweden.
A gainst this background and after proposals from the Study of Integration (SOU 1982:19), the central su p p o rt w ith pre-school advisers and itinerant teachers built u p at Tom teboda School was transferred to the Regional Schools Board in 1984. C o-operation betw een pre-school and school w as m aintained and further education for advisers and itinerant teachers should still be the responsibility of the Tom teboda School. In 1991, the Swedish N ational Board of Education w as discontinued and two n ew governm ent authorities w ere form ed - the N ational Agency for Education and the N ational Agency for Special N eeds Education (SIH). The organisation of advisers and itinerant teachers w as then transferred to this new governm ent authority SIH, w hich is the central adm inistrative authority for the special schools in the country and TRC today. As a result, pre-school advisers and itinerant teachers w ere given a com m on nam e, i.e. adviser for children and adviser for pupils w ith visual im pairm ents respectively.
The tasks and functions of the advisers for pupils w ith visual
im pairm ents have developed and changed in step w ith the changing view of society tow ards pupils w ith disabilities in com pulsory education. The goal today is to transfer the efforts, w hich have been directed to the individual ch ild /p u p il, family and teachers to m ore general tasks. The aim of SIH is now to facilitate the attendance at school for pupils by giving advice and su p p o rt to municipalities. According to a recent proposal, a co-ordinating special
educator w ill be available in each m unicipality in order to offer pupils w ith disabilities an equivalent education (SOU 1998:66; Prop. 1998/99:105). The G overnm ent authorities have changed SIH's task from the proposals, which the Study of Integration once m ade, w here itinerant teachers w ere expected to some extent teach the pupils.
Tomteboda School Resource Centre (TRC)
M any of the proposals m ade by the Tom teboda G roup have been carried out.
The Tom teboda School Resourse Centre has today the task of providing special educational studies and training as well as inform ation, training and further education for the child, the pupil, parents/caregivers, teachers and other staff. TRC now p u ts priority on w ork w ith pupils w ith p rofound visual im pairm ents, as this w as earlier the responsibility of the special school. D uring the pre-school years, it is m ore difficult to decide w hether the child has additional im pairm ents w hich is w hy some children in this group also get the su p p o rt of TRC d uring their first six years.
There is no obligation to register children w ith visual im pairm ent in Sweden. Thus the total num ber of children and young people in the age group 0-20 years can only be estim ated. In the bu d g et year of 1997 about 300 received su p p o rt and training at TRC (TRC, 1997). A round 240 w ere children and young people w ith profound visual im pairm ents, w hich is probably the total num ber in the country. In addition there is the equivalent w ork at Ekeskolan's resource centre (ERC) for c h ild re n /p u p ils w ith visual an d additional
im pairm ents.
Current support to parents
Besides the support of advisers at SIH to the families w ith children and young people w ith visual im pairm ents, courses are offered at TRC for parents, brothers and sisters, as well as other relatives, during the pre-school and school years.
M edical and educational investigations
The first eye specialist w as already em ployed in 1906 by the Institute for the Blind. As a result of the im provem ent in m edical eye care in the country d uring the first half of the 20lh century, m any of the children w ho started at the boarding school in the 1960s w ere well exam ined and m edically treated according to the ophthalm ologist at the school (Olson, 1964). The task as ophthalm ologist at Tom teboda therefore changed to assess, in close co
operation w ith the educationalists, as early as possible w hether the child
should be taught at Tom teboda, in a local low vision class or in an ordinary school (ibid.).
N ew know ledge about the possibility of using and developing residual vision (Barraga, 1964) w as introduced by ophthalm ologist Eva Lindstedt at the beginning of the 1970s w hen co-operation w ith the educationalists was
intensifying (Lindstedt, 1979). A m ulti-disciplinary team of investigators em erged and a low vision clinic w as established w here the p u p il's vision could be assessed and trained. Knowledge of the im portance of training of low vision also lay behind the rapid grow th of low vision clinics in the county councils in the country (Bäckman & Inde, 1979). Between 1973 and 1986, 32 low vision clinics w ere established w ith at least one in each county council.
In 1979, the Tom teboda G roup h ad proposed that the m edical/educational assessm ents, w hich had developed at Tom teboda should be extended and contain a complete analysis of the child's psychological and medical condition.
This w as judged to be im portant for the continuing educational work. The new role of the local low vision clinics and the ophthalm ologic assessm ents w here the child lived in relation to the increased am ount of investigative w ork at Tom teboda w as still unclear. In course of time the co-ordination of these double resources has taken form. N ow the adviser for ch ild re n /p u p ils applies for exam ination of the c h ild /p u p il at TRC after discussions w ith parents and the local low vision clinic. These exam inations function therefore as an extra central resource in those cases w here capability and resources are not sufficient in the m unicipality w here the child lives. D uring the b u d g et year 1997, 111 exam inations w ere carried out at TRC. The dem and for exam inations is large and there is a w aiting list of 2-6 m onths. N ew m edical findings w ithin eye research has increased the dem and for the special com petence w hich can be found w ithin the investigation team today (TRC, 1997).
Teacher training
Additional education fo r teachers
Until 1967 the Institute for the Blind /T om teboda School h ad responsibility for a one-year further education course for teachers of pupils w ith visual
im pairm ents. The m ain em phasis in the course lay in aspects of teaching and practical applications at all levels and subjects in the special school. The course took on a m ore theoretical and academ ic direction w hen it w as extended to a third term and transferred to the Stockholm Institute of Education in 1967. The practical applications rem ained, how ever, d uring certain w eeks in classes in the special school. The training to become a special educationalist specialising in visual im pairm ent is still located in the Stockholm Institute of Education and extends over three terms. The content of the education has, along the same lines as the changes w ithin the area of disability politics concerning "a school for all", m oved d uring recent years tow ards a m ore general special educational competence. It m eans a supervisory and advisory function in com bination w ith specific inform ation about visual im pairm ent and its consequences for the c h ild 's/p u p il's cognitive and psycho-social developm ent. After com pleting the special education training w ith
specialisation in visual im pairm ent, it is possible to w ork as an adviser at SIH, at resource centres, as a com panion teacher in regular classes or as a special educationalist in com prehensive school.
The n ew findings concerning the significance of vision and reading training has b rought about the creation of yet another professional category, i.e. low vision teacher. The training of low vision teachers has also been located to the Stockholm Institute of Education since 1976 (M yrberg &
Bäckman, 1993). The dem ands for basic training as a teacher do not apply to this professional category. It is com m on that occupational therapists,
physiotherapists, optical nurses and also child-care and teaching staff train as low vision teachers. Low vision teachers w ork, after com pletion of the training, in low vision clinics, at resource centres or w ithin vocational rehabilitation training.
Further education fo r teachers
For teachers and other staff w ho w ork w ith c h ild re n /p u p ils w ith visual im pairm ents in the age group 0-20 years in the m unicipality, there are further education courses at TRC, w hich are initiated by SIH advisers. W hen it concerns school age pupils the courses are recruiting com pulsory
schoolteachers. The length of the courses vary b u t are never longer than a w eek d epending on the p u p il's degree of visual im pairm ent, age and the type of education in w hich the child is participating. The regular class teacher of the p upil w ith p rofound or severe visual im pairm ent, w ho will also learn braille, w ill attend three courses of one w eek each in a period of two years. Teachers of ch ild re n /p u p ils w ith low vision do not attend the central TRC arranged courses to the sam e extent. Distance education and regionally arranged courses are therefore proposed for this group in the future (TRC, 1997).
Regionally organised further education by SIH advisers also occurs in co
operation w ith TRC.
Num ber o f children and young people w ith visu a l impairm ents
Medical registration 1994
In 1994 there w ere 2,373 children and young people in Sw eden betw een the ages of 0 and 19 years w ith a visual acuity of <0.3 (6/18) registered at low vision clinics (Blohmé & Tornqvist, 1997a). This m eant that there were
approxim ately 10.9 children w ith visual im pairm ents per 10,000 individuals in this age group (about 0.1%). There w ere 45 p er cent w ith m oderate low vision, 15 p er cent w ith severe low vision and 26 per cent w ith p rofound low vision or blindness according to W H O 's categories (Table 1). For 14 per cent the visual acuity w as unknow n. In 60 per cent of cases there w as an additional
im pairm ent. Visually im paired w ith m ental retardation exclusively (18,5 %) b u t also com bined w ith m otor im pairm ents (27,4%) represented the largest group.
Eighty-four p er cent of the children h ad im pairm ents due to either prenatal (before birth, 64%) or p e ri/n e o n a ta l factors (around birth or just after, 20%). A m ong those w ith prenatal causes half w ere caused by genetic factors.
The children born prem aturely w ere in the majority am ong the p eri/n e o n atal im pairm ents (56%). It w as also m ore com m on w ith additional im pairm ents in this group (83%) (Blohmé & Tornqvist, 1997b). The two largest diagnostic groups w ere neuro-ophthalm ological (49%) and retina diseases (14%). In the first group there w ere m any children w ith additional im pairm ents (88%) and also the largest group of children w ith cerebral visual im pairm ent (CVI).
C hildren w ith m ental retardation often w ere diagnosed as having CVI (40%) (Blohmé & Tornqvist, 1997c). The statistics show the frequencies of additional im pairm ents am ong children w ith visual im pairm ent.
N umber o f pupils in comprehensive school 1997/98
According to educational sup p o rt statistics (SIH) based on registered pupils in com pulsory education (7-15 years) and w ho received su p p o rt from an adviser for pupils w ith visual im pairm ents, 970 p upils h ad a visual im pairm ent in the year 1997/98 in Sweden. Of these 60 per cent h ad an additional im pairm ent and 34 p er cent w ere taught in a special group. Thirty-nine p er cent of the pupils h ad a native language other than Swedish. M any of those had a
p rofound or severe visual im pairm ent (31 %). In the total group there w ere 712 w ith m oderate low vision (73%), 136 w ith severe visual im pairm ent (14%) and 122 pupils w ith profound low vision or blindness (13%).
READING ACQUISITION
Individual incentives
R eading is a w ide and m ulti-dim ensional concept. In order to be able to participate in a high technological society, reading ability is a necessary prerequisite. Contexts including reading activities are increasing daily in such a society (Skolverket, 1996). Also in personal everyday life, a w ell functioning reading ability is needed in order to experience integrity and independence. It is p art of every person's right to be able to read their personal post, private letters as well as m ore official w ritten com m unications from authorities.
The ability to read, how ever, also contains other dim ensions than the
functional. Reading also has a cognitive side. The personal w orld of experience is expanded through reading fictional descriptions of foreign environm ents and other people's w ay of thinking. N ew possibilities for reflection are created as well as the ability to reconsider our understanding of the w orld around us.
W hen these new experiences can be transform ed into the form of conversations about the reading experience w ith other persons w ho are im portant for us, reading takes on further emotional and social dim ensions (Mead, 1934; Taube, 1988). Positive experience of reading thus satisfies m any fundam ental needs from the perspective of the individual and are, therefore, an im portant m otive for learning to read. The personal m otive for learning to read varies w ith necessity and is related to age, personal reading needs and the reading dem ands in the person's environm ent.
Social demands
It is, how ever, not only ow n satisfaction and reading needs w hich control m otivation of learning to read. T oday's society also places demands on reading skills. School and society im pose reading tasks on us, a reading, w hich is relatively lacking in any com prom ises, as w e often do n o t choose our reading tasks. In order to m anage tasks at school and at w ork, reading ability of another nature is required than that required for reading for pleasure.
Everyday reading situations thus vary betw een individual needs and contextual dem ands in relation to ability. W hen reading ability corresponds to the individual's ow n and everyday reading needs and dem ands, the concept reading competence has been used in this thesis. Reading competence is
therefore, a relative concept based on the relation and interaction betw een the preconditions of the individual and h is /h e r surroundings. A person w ith reading com petence reads and understands, adapts reading strategy to the reading task, uses h is /h e r reading ability in daily life and m eets the reading dem ands w hich are expected from people in h is /h e r surroundings. In order to express an opinion about som eone's reading competence, therefore, it is necessary to know the individual's capability, reading task and reading dem ands.
Reading ability, on the other hand, is defined as the individual's ability to decode text and understan d its m eaning, i.e. processes occurring during reading on sensory, perceptual, verbal and cognitive levels (Paper I). Different reading tasks m ake different dem ands even at these levels, w hich is w hy reading ability can vary for one and the sam e person depending on reading situation and surrounding circum stances in school and during leisure time.
Theoretical perspectives
H ow then does reading ability and reading com petence develop? The standard used in this thesis for the developm ent of the individual is that the child is a being, w ho actively searches for know ledge and in interaction w ith h is /h e r surroundings, develops abilities and skills. The individual, as well as the surrounding environm ent, are active partners in this interaction. The individual influences and is influenced by the environm ent and vice versa.
Kylén (1988) describes in a m odel the interaction betw een the potential of the individual and aspects in the environm ent. The individual is regarded, according to his theory, as a biological and psychological being w here both aspects influence each other in a m utual and inseparable interaction. In the sam e w ay, the environm ent is regarded as physical and social. People, the social environm ent, populate the physical environm ent.
"To understand a human being, therefore, one needs in every situation to know the psychological and biological aspects of that human being and the social and physical aspects of his or her environment. Each of these four aspects has its own structure, dynamics and development. "
(ibid., p. 9)
Kylén em phasises the dynam ics in the interaction betw een the structures and those relations w hich are changed in pace w ith the individual's psychological an d biological developm ent as well as changes in the social and physical environm ent. Kylen's general m odel and view of the interaction has been one of the theoretical bases for the m odel of interaction for developm ent of reading ability and reading com petence for ch ild re n /p u p ils w ith visual im pairm ents in this thesis (Figure 1). The biological aspects, the nature and degree of the visual im pairm ent, as w ell as any additional disabilities, m ust be regarded
together w ith the child's psychological resources and the conditions in the physical environm ent w hen m aking judgem ent of reading ability and reading competence. A teaching environm ent, w here low vision or blindness does not become decisive for the child's further developm ent is, w ith this approach, very im portant. This perspective agrees well w ith W H O 's relative handicap concept w here lim itations due to functional im pairm ent is decided in
encounters w ith the surrounding environm ent. In an environm ent w ith good physical and social conditions, the visual im pairm ent becomes accordingly less noticeable and the child is given opportunities to develop h is /h e r
potential ability. Vygotsky (1978) has also em phasised the im portance of socio
cultural interaction in order for the child to be able to develop further from his actual developm ent level. He talks about "the zone of proxim al developm ent"
(ZPD) w here the child has the opportunity of developing inherent resources during particular circumstances, e.g. in co-operation w ith or in interaction w ith m ore capable people. H e defines the nearest developm ent zone in this way:
"It is the distance between the actual developmental level as determined by independent problem solving and the level of potential development as determined through problem solving under adult guidance or in collaboration with more capable peers."
(ibid., p. 86)
W ith this perspective, the educational process becomes im portant for, and determ ines, the child's learning. Education m ust be based on those processes, w hich are u n d er developm ent in every c h ild /p u p il if it is to stim ulate further developm ent of higher cognitive processes. Reading is such a process. W ith this theoretical basis, the learning environm ent of pupils w ith visual
im pairm ents is very im portant in order to develop reading ability and reading competence. It presum es access to people w ho know about, and have
experience of, the consequences of visual im pairm ent for reading
developm ent in order to give the p upil possibilities for optim al developm ent.
It also presum es that tools exist in order to, e.g. develop w ritten language w hich is m ost fundam ental in order to become aw are of language (Vygotsky, 1986).
A developm ent theoretician w ho started from V ygotsky's theories, b u t has further enhanced the significance of the environm ent for the developm ent of children, is Bronfenbrenner (1979) w ho developed a theoretical system - ecological developm ent model. The levels in this are described as hierarchical, composite structures, w hich stretch from the micro system, through the meso- and exo-systems to the m acro-system . The basis is the child and the conditions in the environm ent for h is /h e r developm ent. The child influences and is influenced by the activities and roles h e /s h e possesses in the im m ediate surroundings (micro-level) and the social relations w hich are developed in interaction w ith family, pre-school, school and friends (meso-level). The child can be inspired by others, obtain new role m odels and the desire to try new activities w hich lead to developm ent. The surroundings can, in this
interaction, strengthen or w ork against the child's developm ent in the current activity. The relations, w hich are developed betw een the child's various im m ediate surroundings takes place at the meso-level. Positive relations in the im m ediate surroundings encourage the child's developm ent.
Bronfenbrenner also refers to other levels in society, w hich indirectly influence the child's im m ediate surroundings. Various form s of com m unity su p p o rt in the child's hom e environm ent belong to the exo-system, as does the parents w orking situation and different social netw orks. The interaction on the exo
level can be disturbed or stim ulated both w ithin the system an d from adjoining systems, e.g. by political ideologies in the com m unity as well as economic and political conditions in the macro-system.
Bronfenbrenner revised his theory at a later stage by highlighting the developm ent of individuals an d their potential over time (Bronfenbrenner, 1989). He developed then a bio-ecological m odel w here he em phasised the im portance of continuity and positive relations in the im m ediate environm ent ("settings") in order to increase the effect of proxim al processes for the
individual's developm ent (Bronfenbrenner & Ceci, 1994). Fischbein (1986) also points ou t in her educational, interaction m odel how various structural factors at different levels affect the educational process in the classroom and shows
the significance of guidance and stim ulation for individual developm ent in general (Furu, Fischbein & Rosenqvist, 1994).
W ith the same theoretical perspective, W arren (1994) also raises new research questions about children w ho are visually im paired and their developm ent w hen he writes:
"Children with visual impairment have certain abilities and characteristics, and they encounter a variety of environmental circumstances to which they must adapt. What is the nature of the reading adaptation, and how does that adaptation change with changes in the child's abilities and characteristics, on one hand, and with changes in the environmental circumstances on the other?"
(p. 6)
Reading developm ent is a life-long process (Rex et al., 1994). Reading ability is im proved by being frequently used in m eaningful contexts, w hich also give an increased variation and b readth of reading tasks. Using this ability also gives an increased frequency of reading w hich influences the developm ent of reading ability positively (Stanovich, 1986). In pace w ith increasing dem ands on reading in different reading situations, opportunities for w ell-developed reading com petence is also created, i.e. opportunities for reading various types of text in different contexts (Myrberg, 1997).
Q uestions about how children and young people w ith visual
im pairm ents acquire reading ability and reading competence in their natural reading environm ent has, on the basis of these interaction theories, been central to this thesis. C h ild ren /p u p ils have been studied in their im m ediate surroundings, above all in school. People w ho have been im portant for the child's reading developm ent have also p rovided inform ation about the child's reading activities and about the teaching situation in several studies (Papers II, III, IV and V). The outcom e of reading com petence has, how ever, only been possible to illum inate in the first study as the pupils in other studies have been at the beginning of their reading developm ent and m uch too young in order to have m anaged to develop reading competence.
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Figure1.An interaction model ofreadingaquisitionofchildrenand young peoplewithvisual impairment based onBronfenbrenner & Ceci (1 Fischbein (1986)and Kylén(1988).
AIMS A N D RESEARCH QUESTIONS
The overall aim in this thesis is
• to increase the know ledge and understanding of reading acquisition in pupils w ith visual im pairm ents in m ainstream education
• to find factors w hich influence reading acquisition of pupils w ith visual im pairm ents from an individual as well as an environm ental perspective.
Some im portant research questions w hich are focused on:
- W hat are the similarities and differences betw een sighted pupils and pupils w ith visual im pairm ents of the same age w ith respect to reading
perform ance of different types of texts, reading habits and interests?
(Papers II an d III)
- W hat is the variation in reading perform ance w ithin the group of pupils w ith visual im pairm ents in relation to visual conditions, reading m edium and reading devices? (Papers I, II, V)
- U nder w hich circum stances w ill the visual im pairm ent cause reading problem s? (Papers I, II, V)
- W hat factors can be identified in the learning environm ent, w hich prom ote the reading acquisition of pupils w ith visual im pairm ents in an optim al way? (Papers I, III, IV and V)
THE VISUAL SYSTEM AND READING
The visual system
Vision is the collective result of the functions in the eye, the pathw ays of the brain and cortex. The anterior and posterior pathw ays lead the visual im pulses on to the prim ary and associated areas of the cerebral cortex w here the picture is processed and interpreted. In an individual w ith norm al vision b oth in p u t and processing of the visual inform ation are w ell functioning.
N orm al vision provides a good basis for visual perception of letters and words.
Figure 2. The visual system.
W ithin m edicine the focus is on visual functions and their m easurable values w hile for educationalis ts/unctionaZ vision (visual ability) in daily activities is central. These concepts are often m ixed in the professional discussion, w hich som etimes could be confusing. The distinction betw een them is presented in the following to m ake it clearer.
retina optic n e rv e
c h ia sm
lateral g e n ic u la te b o d y - lateral I v e n t r i c l e !
p o ste rio r
* visual p a th w a y s
► an terio r visual p a th w a y s th e e y e a n d
Visual functions
The visual system com prises several different visual functions (Lindstedt, 1998; Rydberg, 1998):
- Visual acuity: a m easure of the visual system 's resolution, i.e. the capacity to discrim inate details.
- Visual field: that area/sp ac e w hich can be seen w hen the eyes are fixed on a certain point.
- Contrast sensitivity: detection of the differences betw een brightness (luminance) of tw o adjacent surfaces.
- Colour vision: perception and distinction betw een different shades of colour.
- Visual adaptation: functioning in different lighting conditions.
- Ocular motor functions: the capacity to fixate, to m ake saccadic and p u rsu it m ovem ents w hen reading w ords on a line.
- Accommodation: the adjustm ent of the lens for near vision to be able to project a focused picture on the retina.
- Visual perceptual and cognitive functions: the processing, organising and interpretation of visual input.
The various significance of each function for decoding letters and w ords m ust be know n if w e are to be able to assess the potential of these visual functions for the reading process. Each one of the visual functions can be m easured using different m ethods or instrum ents. The m easures of the visual functions only indicate the potential visual ability and not the functional visual ability in different daily activities. In earlier studies, for example, visual acuity has show n to be a poor predictor for reading ability in children w ith visual im pairm ents com pared to adults w ho acquire a visual im pairm ent (Myrberg, Bäckman & Lennerstrand, 1996). One m easure of a single function could be m isleading. To start from only visual acuity w hen recom m ending reading m edium and reading devices for individuals w ith visual im pairm ents is not sufficient. The visual ability could then be overestim ated and the
recom m endations incorrect. The question of the visual functions' relation to
