Examples of Strategies for Teaching Non-Visual Skills and Use of Non-Visual Information
To People with Functional Vision

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"Joe walked with a blindfold for several blocks from the bus stop and found his home independently with no problem. He took off his blindfold in the driveway, pleased with his success. But then he couldn't find the sidewalk that led from the driveway across his small front yard to his porch. He walked in the driveway alongside his house all the way to the back yard, without realizing he had walked way too far, and without noticing the dramatic echolocation cues of the house a few feet away from him. We talked about using non-visual information, as he certainly would have found it easily with the blindfold on.

"On his lesson the next day, he did very well with a blindfold while walking across a wide parking lot entrance along a highway. Later, when he walked the same route with the blindfold off, he was unable to recognize where he was and what his cane was detecting."

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This incident, excerpted from the progress notes of a client I taught in the spring of 2008, typifies what often happens when training people who have functional vision. It is a challenge to teach them to use non-visual information when they are in the habit of relying on visual information and ignoring everything else. However, it can be done.

Following are examples of three strategies for teaching people who have functional vision to use non-visual information and techniques. These strategies are:

intermittent occlusion;

partial occlusion; and

drawing people’s attention to non-visual information without any occlusion.

These have proven to be very effective teaching strategies, but only for those who want to wean themselves from reliance on visual information and be able to notice and use non-visual information for everyday situations. They are not as likely to help those who are not motivated to use non-visual information, such as those who feel that their vision provides them with sufficient information in all conditions, and/or those who are doing the exercises merely to please an instructor who has convinced them it is best to learn to use non-visual information now in preparation for the possibility of losing vision later.

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Strategy 1: Intermittent Occlusion

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With intermittent occlusion, the clients perform tasks visually, then repeat with a blindfold or eyes closed to help them notice the non-visual information, then repeat the task again without visual occlusion while using the non-visual information that they had noticed previously. Some examples are:

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(1) During an O&M lesson in a residential area with many fallen leaves after a recent rain, a man walked along a sidewalk adjacent to the street, with no grass between the sidewalk and the street. When he saw a bright yellow garbage can in a driveway ahead, he walked around the can but at the bottom of the driveway he entered the street unaware. He walked along the street for a while and then wandered back onto the sidewalk without noticing he was stepping up onto the curb (the curb's height was only about two inches there, and the gutter was piled with leaves). When I approached him, he said he was not aware he had ever been in the street. I did the following:

Have him go back and walk the same area with his eyes closed. This time, with no visual distraction, he found the garbage can with his cane and used the cane to search the sidewalk to see where it was clear to walk around the can. He again entered the street but this time he was able to notice, even though the gutter was subtle, because he could feel with his feet that the surface sloped down and then up (weeks ago, he had learned to notice even subtle gutters with his feet by shutting his eyes while I guided him across the gutters and report when he entered the street). He then resumed his way around the can without stepping into the street.

We went back to the beginning and I had him shut his eyes while I guided him the same way he had originally walked (around the can, into the street, and back onto the sidewalk). With no visual distractions, he easily recognized when we entered the street by noticing the slopes, and recognized when we stepped back up on the curb.

With his eyes open, I guided him again along the same route down the driveway and into the street and back onto the sidewalk, and asked him to notice those same slopes and curb that he had noticed earlier. This time, even though he was again distracted with vision, he was able to notice the non-visual information of the slopes and curb.

Finally I had him walk it again himself, with eyes open but noticing the wealth of information from the cane and feet. He negotiated the can and the driveway beautifully.

Lest you think that the skill of using non-visual information can be taught with one incident such as this, you should know that this man continued to ignore good non-visual information most of the rest of that lesson. He would hesitate, lean forward to see better, sometimes doing well and sometimes making mistakes with faulty visual information. Each time I saw him trying to rely on his vision, I waited until he negotiated the area and then, regardless of whether he had negotiated it successfully or not, I had him do it again with eyes closed to notice the non-visual information. This was followed by doing it again with eyes open so that, while he was distracted by the vision, he could notice and use that non-visual information, and not rely only on vision that is often insufficient or even faulty.

As the lesson progressed, he started actively searching with the cane and using the non-visual information without pausing and bending forward to try to look. However, near the end of the lesson, he crossed an unfamiliar street while relying on his vision, but with the sun's glare on a street filled with puddles, broken pavement, and leaves, he crossed with a lot of hesitation, moving left and right, and ended up missing the other corner and walking along the parallel street. In previous lessons he had crossed similar streets very well with his eyes closed, usually after crossing first with eyes open and then feeling ready to try it with eyes closed. On this occasion, when he did it so badly with eyes open, I chastised him saying, "I KNOW you can cross this street easily with your eyes closed!" So I guided him back, had him close his eyes and use one of the non-visual techniques he had learned for aligning, then cross with his eyes closed. His crossing was perfect and, when crossing, he appeared to be confident rather than hesitant as he had with his eyes open. I then had him do it again with eyes open, and he was able to line up again with the same non-visual technique, and cross with confidence even though the vision in that situation gave him nothing but distraction and misleading information.

Still, I knew from experience with other clients that this man’s progress in developing the skill of using non-visual information in his daily travels would be slow and would have to be reinforced many times with more intermittent occlusion before it would become a natural habit for him to use the vision and the non-visual information together. If I had trained him predominantly with a blindfold, I know he'd be able to do it well with a blindfold, but I also know that without the training with intermittent occlusion, he would never learn to use the vision and non-visual information together, and when the blindfold came off he would not be the skilled traveler that he eventually learned to become.

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(2) A woman received instruction in cane and orientation skills almost exclusively with her eyes closed, and became proficient and confident. However, on her first lesson where she walked under normal conditions (with eyes open), she approached a stairway where she could see an electric cord draped over some of the steps. She almost bent over double, straining to see the cord and where to step. I had her start again but with her eyes closed and using her cane find the cord and the clear steps. She did this easily. I then had her ascend again with eyes open, using the cane to find the cord rather than straining to use vision that was insufficient in this case, and she did well.

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(3) The following scenario was repeated by numerous people with low vision. They had learned to use the cane well indoors, sometimes with occlusion and sometimes without, and had achieved the most advanced level of cane proficiency. This scenario happened when they were on one of their first lessons outside and approaching a curb. They each leaned forward and strained to see where the edge was. I let them find the edge that way, then had them close their eyes while I guided them back so they wouldn’t know how far from the edge they were, and approach the curb again with eyes closed. They always did well, as they had done indoors, and found the edge with confidence. I then guided them back (again, confusing them as to how far from the curb they were) and had them approach the edge under normal conditions (i.e. with eyes open), using the cane as they had done before. They each did well, and this time found the curb without straining or struggling.

Most of these students needed to repeat this experience because the next few times they approached an edge, they again strained to see it, rather than remembering to rely on the non-visual information from their cane. After enough of these experiences of intermittent occlusion, they started to notice and use the cane to detect the curb with confidence without further prompting.

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(4) A woman who had learned to use the cane without any occlusion was traveling along an unfamiliar sidewalk in her neighborhood. She approached a stair that she didn’t realize was there because the sidewalk looked flat. However as soon as the cane went over the edge, she stopped* and then leaned forward, trying to see the edge [see photos below]. Normally, when people ignore cane information and try to rely on their ineffective vision I allow them to struggle before having them do it with eyes closed but in this case I had her stop, since walking in that position made her balance precarious and I felt it was dangerous to allow her to continue in such a position. So I asked her to step back and close her eyes and use the cane to find the edge and negotiate the stairs as we had practiced. She did well. I then had her return to descend the stairs again, this time with eyes open. She again leaned forward straining to see the edge, but I told her to look ahead, and use the cane to find the edge, paying attention to the cane while looking ahead. She did it well. Most people need more than one experience like this to help them use the non-visual information automatically, and she was no exception – she did the same thing several more times and needed this experience of intermittent occlusion each time before she finally started to use the non-visual cane information without prompting.

* Her stopping indicated that even though she had not had any partial or intermittent occlusion during her training, she was functioning in the fourth and final level of cane proficiency – that is, she noticed the cane information reliably and recognized there was a step there, even when distracted with misleading visual information. However, once she noticed the edge, she went into “vision mode” and tried to rely on her vision to negotiate the stairs while ignoring the cane, demonstrating the need to learn to use non-visual information when the visual information is unreliable and insufficient. Intermittent occlusion was effective for helping her achieve this.

Illustrations of this example:

BELOW: Even though the sidewalk looked flat to her, this woman was able to notice the edge of the stair as soon as the cane went over the edge. However, as she approached it, she leaned forward and looked down to try to see the stair edge and railing.


BELOW: In contrast, when she closed her eyes to approach the edge, she appeared poised and well-balanced, and relied completely on the non-visual cane information.


BELOW: After this experience, she descended the stairs again but with her eyes open, intentionally looking forward rather than looking down, and worked hard to ignore the vision and concentrate on the non-visual information.

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Strategy 2: Partial Occlusion

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Partial occlusion typically occludes only the bottom part of the vision, so that the students are still able to see ahead of them and look around, but they are unable to see anything on the ground directly in front of them. The only way they can know what is on the ground is to use their cane. This gives students the experience of being distracted with vision while having to rely for their safety on non-visual information from the cane. It is effective for simulating situations where the vision is functional but insufficient or unreliable, to help students reach the fourth and last stage of learning to use a cane – that is, be able to notice and use the cane information regardless of the distraction of visual information.

However partial occlusion should not be introduced before the students have reached the third level of cane proficiency (that is, before they are able to move the cane correctly without concentrating) for several reasons:

Until they reach this level, the instructor should avoid distracting students with other tasks while they concentrate on learning to use the cane.

More importantly, partial occlusion is intended to develop a trust of cane information and, if they don’t have reliable cane protection (as was the case with a woman who fell off the subway platform while using her cane because she hadn’t become proficient with it), partial occlusion may backfire and students develop, with good reason, a distrust of the cane that will be difficult to overcome.

NOTE: When students begin partial occlusion to develop trust and awareness of the cane, they should be aware of the three things that the cane may not detect, so they are prepared and not disillusioned when they realize that it doesn’t protect them from everything.

Partial occlusion has a secondary benefit for students (such as those with retinitis pigmentosa) who tend to focus all their attention on scanning the ground visually to detect obstacles and edges, often walking with their head lowered and oblivious to what is around them. It helps them realize how dependent they are on looking down and, if they have developed a reliable cane technique, they may learn that it is not necessary to look down.

There are several ways to partially occlude the vision (shown below):

Glasses with paper taped to the bottom half of the lenses;

Goggles with material (cardboard, plastic) filling the bottom half of the lens opening;

For outside travel, sunglasses with tape inside the bottom half of the lenses.


The placement of the occlusion material will depend on the individual. It should allow the student to see straight ahead but not see the ground in front of the feet, as shown below. After positioning the occlusion, ask the student to hold his head upright and report what is visible, then reposition the material to occlude the desired amount. Commonly, the area that is occluded is the ground about 15-20 feet in front of the student, but you may wish to occlude more or less, depending on the situation and goals.


ABOVE: (left) view without occlusion; (right) view with partial occlusion

Exercises we do while the student is wearing the partial occlusion include the following (throughout these exercises, the instructor is prepared to provide for safety if the student keeps walking toward the edge without noticing it):

Student walks through various familiar and unfamiliar routes, including stairs or curbs, becoming accustomed to relying on the cane for surface information;

Student walks through an obstacle course of low obstacles or walks where there are curbs and steps;

To give the student the experience of using the non-visual information while distracted, the instructor assigns visual tasks for the student to do while walking among obstacles or curbs, such as counting the number of dark-colored cars, or counting how many doors in the hallway have handles on the left, or watching the instructor and counting how many fingers he is holding up, etc.

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Strategy 3: Drawing attention to the non-visual information without occlusion

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One strategy for teaching the use of non-visual information is to simply draw the students’ attention to it and help them understand the implications of the information. When this is done without any occlusion, it can be very effective for helping students learn to notice and use non-visual in their everyday lives. Illustrations below are but a few examples of this teaching strategy, which is a natural part of every effective O&M program for students with low vision.

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(1) After 6 indoor O&M sessions in three weeks (8 hours of training, sometimes with occlusion), a woman with low vision had gained preliminary skills with orientation and had tentatively reached the fourth and final level of cane use (see "Stages of Learning to Use a Cane"), and was therefore ready to begin training outside. On her third outside lesson, while walking on a sidewalk along a street with a stop sign at the next corner, the sidewalk seemed to end suddenly, as she could see only grass in front of her and no more concrete. She strained to see the sidewalk but her vision was too limited. She became distressed and asked where the sidewalk was and whether she had reached the corner.

After she calmed down, I asked her to listen to the cars on the street beside her. She heard them pass her and stop about half a block ahead. I asked her to figure out where the corner was, based on the cars’ movements. At first she didn’t know, but after I asked her to describe the next intersection, she remembered there was a stop sign at the corner. After thinking some more about the traffic movement that she heard, she realized she wasn’t at the corner, she was in the middle of the block. When she asked again about the sidewalk, I asked her how she could find it. She was frustrated but thought about it, and then started to search the ground with her cane. She found that the sidewalk had turned toward the buildings, so she followed it for about a car length then found that it turned again to resume toward the corner (she did not need further prompting to explore with the cane to find where it went). So in this situation, she was able to experience listening and feeling for the information that was present and use non-visual information to answer her questions without occlusion or closing her eyes.

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(2) The following scenario happened to several men with low vision. In each case, as the man and I walked to the building where we would begin our O&M training, I told each man that there was a doorbell beside the door and asked him to find and push it. Each man leaned forward, pressing his face within an inch of the wall and searched for the button, unable to find it until after about a minute of searching with his face. I let him struggle till he found it, then asked him to find it again but use his hand to scan the wall instead of straining to use his vision. One of them did it without further prompting but the other man had to be shown how to place his hand on the wall and move it from side to side looking for the button. They each found the button easily using this non-visual technique. I made no comment about which method was better but after that experience, whenever we approached the door each man reached forward with his hand and scanned to find the button instead of peering close and straining to find it visually.

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