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Reflections on the Career of a Vision Rehabilitation Therapist: 1975-2007

Paul E. Ponchillia

Print edition page number(s) 745-748

When I was asked to write about the rewarding profession from which I recently retired, I was flattered and eager to begin writing. However, when I sat down to put my thoughts into some semblance of order, I was surprised to discover that it was a much larger task than expected. I decided to simply tell my story, with the objective of describing the wonders of having spent a life's work in vision rehabilitation therapy.

The first half of my life was spent preparing for and conducting research in plant pathology. Many people come to blindness and low vision studies from an unrelated field, but not many spend time in their first profession peering down at 300-micron worms through 1000x magnification! At age 30 years, a hunting accident resulted in total vision loss and ended my career in science, but opened the door to my real love--vision rehabilitation therapy. The skills gained in my pursuit of scientific research, combined with earning a post-doctoral master's degree in vision rehabilitation therapy, teaching in a rehabilitation center, and experiencing my own journey of adjustment with blindness, were training for my days in personnel preparation and research.

Following those days of early learning, I taught in the Vision Rehabilitation Therapy program at Northern Illinois University and then at Western Michigan University for 29 years.

Vision rehabilitation therapy: State of the art, 1975

Two aspects of my 30-plus years in vision rehabilitation therapy strike me as significant: the phenomenal change in the technical tools of the profession, and the development of the profession itself. Perhaps the simplest way to approach the changed technology is through the writings of Father Thomas Carroll, the chaplain of the post-World War II blind rehabilitation unit the Army's Experimental Rehabilitation Centers in Connecticut and Pennsylvania. Fr. Carroll's "20 losses," which he spoke of in his book Blindness (1961), provide a useful context to explain the significance of developments in technology. Three of these losses were of particular interest to me, both as a therapist and as a consumer, when I began my practice in vision rehabilitation therapy: Loss of informational progress--that is, my clients' and my own inability to keep up with the news, current events, and so forth; loss of ease of written communication--the problems that vision loss imposes upon the tasks of reading and writing print; and loss of activities of daily living--the difficulty of performing tasks needed to sustain an independent lifestyle.

Following my own vision loss, I certainly viewed my inability to read such items as the newspaper, community bulletin boards, scientific journals, and marquees of movie theaters as serious losses. Similarly, losing the ability to compose a simple manuscript on a (then) state-of-the-art typewriter was devastating. In addition, figuring out where to get goods and services, particularly clothing and other personal items, locate a store's telephone number, and then figure out how to travel to and find the store were beyond what I considered to be simple barriers. When, as a vision rehabilitation therapist, I went about attempting to convince new clients, now known as customers, that there were good "work-arounds" for these three losses, I did not have much to offer in the way of sources of local news and information, unless there was a radio reading service in the area. Other reading resources were the Talking Book Program for books and some magazines; and a few really talented souls were reading with early closed-circuit televisions or Optacons (electromechanical devices that presented print in vibratactile arrays). Customers used typewriters to compose print documents although it was far from easy. Getting consumers to retail stores was more complex and required elaborate audio maps recorded on audiocassette with descriptions of store layouts, hand-in-hand work with an O&M specialist at the store, and the tasks of obtaining the telephone number and directions and making a route to the store.

The beginning of a profession: 1975

By 1975, 15 years after rehabilitation teacher--now known as vision rehabilitation therapy--training became based at universities, the profession was just a swelling bud. Its body of knowledge was contained primarily in dittoed pamphlets and in the minds of its practitioners; its certification process was overseen by peers; there were just a handful of students in academic programs; it had no written code of ethics; and it struggled for a professional identity, even within the blindness field. Vision rehabilitation therapy training was, in many ways, still thought of as "home teaching"--its original name--and a job for people who were blind. In fact, the vast majority of therapists at the time did have visual impairments.

What losses? 2007 and beyond

What amazing things can happen in 30 short years! Most of the limitations described in the three loss categories mentioned earlier can be nearly eliminated by using the latest technology. It is exciting to know that vision rehabilitation therapists now go to peoples' homes armed with tools and knowledge to help customers locate information and news through telephone database services such as Tell Me and Newsline. Equally as exciting is the knowledge that we can teach individuals to access information on the Internet through accessible computers or by the simpler technology offered by System Access Mobile Network (formerly FreedomBox). In addition, reading print documents using reading machines, converting print to hard copy or refreshable braille with ease, downloading e-books from Internet sites, or purchasing audiobooks in the general marketplace have opened reading to a level not imagined when Fr. Carroll wrote his treatise on losses. Composing documents like this one has also become extremely accessible.

And what about shopping? Shopping for anything made by mankind is available on one or another Internet site. The process of locating and traveling to stores has also come light years since 1975. Together, vision rehabilitation therapists and O&M specialists can teach a customer to search for a favorite store or service with the Internet or with a feature of accessible GPS devices and then work on getting there. With a GPS device, one can perform a search, get the telephone number from the GPS database, and call to check on the availability of a product or make an appointment. If an individual has O&M skills, he or she can use a GPS device to determine a travel route to a store and then use the device to stay on the correct route from home to the store and back again.

All these electronic wonders make it appear that, in 2007, we should be able to cross the losses of informational progress and ease of written communication off Fr. Carroll's list. In addition, many of the barriers related to activities of daily living can be considered passé. The only real barriers that keep us from ridding ourselves of these losses are the lack of the financial resources to provide devices and training to people who need them.

The profession of vision rehabilitation therapy, because it consists of people rather than electronic devices, could not possibly have progressed at the same lightning speed as have its teaching technologies. In the past 30 years, however, it has made the following giant steps forward: a published literature containing its body of knowledge in professional textbooks, a legitimate certification process, a code of ethics, a professional organization increasingly supportive of its fellows, and a number of university-based personnel preparation programs that include significant expansion of distance education offerings. The profession also has unquestionable autonomy and highly dedicated members.

The value of a profession

The one aspect in which this profession may appear not to have grown significantly is in professional recognition and identity. I recall my mentor, vision rehabilitation therapy pioneer Ruth Kaarlela, telling me in the early 1980s how proud she was of how rehabilitation teaching had grown professionally since the 1960s. She said, "It still troubles me that, in spite of our growth in training, certification, and standards, we are still not well recognized." My interactions with national leadership over these past years make it clear that her conclusion is still valid. Knowing that one's chosen career does not seem to carry the professional recognition or status of others might be disheartening. However, I feel strongly that recognition is of little import when compared to the value of its services. Recognition, much like personal popularity, is not a measure of worth. Knowing that vision rehabilitation therapists carry the primary responsibility for service delivery to older persons with visual impairments, that they provide the majority of instructional hours to adults in residential rehabilitation centers, and tend to be the single most common contact between customers served in their homes and vocational rehabilitation agencies, indicates the importance of their role in the rehabilitation process.

In the end, it is the knowledge of one's impact on an individual, not recognition, which results in one's long-term satisfaction with his or her life's work. Those memories that are held dearest to me, other than those connected to my family, are all vivid images of changed people, people who came to me in the depths of defeat and went away with the glow of knowing that their visual impairment was just another of their attributes. Knowing that I played a significant role in their awakening shows me clearly the value of vision rehabilitation therapy. I leave this fantastic work much closer to what the humanistic psychologist Abraham Maslow called "self-actualization" than when I joined it. What more could anyone ask of a profession?


Carroll, T., Jr. (1961). Blindness: What it is, what it does, and how to live with it. Boston: Little, Brown & Company.

Paul E. Ponchillia, Ph.D., professor emeritus, Department of Blindness and Low Vision Studies, MS 5218, Western Michigan University, Kalamazoo, MI 49008; e-mail: <>.

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