How to Communicate with People Who are Blind or Vision Impaired
Part 2: Assistance, Access and Technology
Monday October 12, 2020
Most children with retinoblastoma and survivors have some degree of sight loss, and many experience awkward healthcare interactions as a result. This 3-part series shares survivor and parent tips for medical professionals working with people who are blind or vision impaired, Part 2 focuses on assistance, access and technology.
Offer your arm when guiding
This is part 2 in a mini-series sharing guidance and insights to aid effective communication with people who are blind or vision impaired.
WE C Hope child life specialist, Morgan Livingstone, and her former intern, Jocelyn, gave a series of talks earlier this year about communication between medical professionals and patients, parents, colleagues and students who have sight loss. Jocelyn has lived with low vision since childhood, and Morgan asked our retinoblastoma community for insights to deepen her understanding, particularly of issues specific to retinoblastoma care.
Over three posts, we share the vast range of responses from parents and survivors. In this series, you will find:
- General Meeting and Interactions (28 September)
- Offering Assistance, Access and Technology (Below)
- Medical Care and Support (26 October)
We hope you find this detailed advice and insight very valuable as you continue to bring the best care to your patients and their families, and work together with us to advance care.
DO ask the person if and how they need assistance. Don’t make assumptions about the individual, and never direct your enquiry to a companion (“does she…”). If the person is seated, remain standing or take a seat next to them if possible. Do not bend or crouch down to speak. This stooping/crouching position is one an adult might adopt when addressing a child, and many adolescents and adults with a disability find it very insulting. Sitting beside us is a subtle sign of respect and equality.
Greet the person, identify yourself, and ask: “do you need assistance?” The person will accept or decline your offer. Listen to their response and, if help is requested, assist as needed. Don’t be offended if your offer is declined, it will likely still be appreciated when offered with discretion and respect.
DON’T touch Canes/Guide Dogs or distract Guide Dogs. The cane or guide dog is an independence aid that helps people with sight loss navigate the environment safely. Relocating it without the person’s knowledge, or grabbing hold of it to “guide” the person risks injury, and causes significant unnecessary distress.
“Going through a phase of rebellion against my own sight-loss some years ago, I shamefully grabbed a cane from the hand of a young blind girl at an event we attended together. I don’t know what possessed me to do it – a momentary irrational thought that we’d be better off walking together arm in arm. Of course I apologized to the child and her mother and nothing more was said of the incident, but the knowledge of how wrong that was has burned into my soul and still springs tears when I think of it. I of all people should have known better.”
Guide dogs are also trained to follow their handler’s instructions and make decisions that keep their handler safe. They can’t do this well if they are distracted. Always ask the handler before making eye contact with, speaking to, or touching their dog, no matter how adorable and irresistible it is, and even if it seems to you that the dog is at rest. Do not be offended if the handler says “no” – they don’t have an issue with you, they are simply managing the work environment for the dog and themselves.
DO always ask the person how they would like to be guided before you begin, and listen carefully as they explain. The person will usually ask to take your arm (just above your elbow) – and you could offer guiding assistance by asking “would you like to take my arm?”. In this case, relax your arm and keep it tucked in to your side. Walk at your regular pace.
Taking the person’s arm uninvited is both inappropriate and impractical because it puts the person one step ahead of you. By offering your arm, you put yourself one pace ahead. The person you are guiding will be more able to detect changes in terrain, slopes, steps, etc., even if you forget to describe them.
Detailed verbal cues remain very helpful. For example, not just that a slope is approaching, but that it is going down, or that steps are going up. Be careful with your terminology – “incline/decline”, “ascending/descending” etc. – in my experience, many people muddle these up, and incorrect instructions can be more dangerous than none at all. I prefer simple “up/down” as I can rely on the fact.
DON’T point, or say “over there” when giving directions. Stand facing the same way as the person you are directing, to ensure your left and right instructions are correct. You could also ask the person if you may help them turn in the correct direction to give them a straight trajectory to their target (“would you like to take my arm so I can point you in the right direction?”).
Use clear description and be specific. For example: “the desk is straight ahead, about 20 paces, the floor is clear of obstacles between here and there”, or “to get to the stairs, follow the hallway straight on for about 30 metres, past a coffee shop on the right. Stay to the left of the hallway as there is a cleaning cart outside the coffee shop. Go through the double doors directly ahead. You will find the stairs immediately on your left, and a bank of elevators on your right.”
DO describe the layout of a room. A brief description of how the furniture is arranged can make navigation easier and safer, and communication better. For example, a conference room might be described thus: “the room is rectangular with the short wall behind us. The table is U-shaped and we are at the open end. Floor to ceiling windows run the full length of the left wall, and there’s a second exit door half-way along the right-hand wall”.
Also describe (and remove if possible) all obstacles in a person’s pathway. Give adequate room around obstacles and hazards, and remember to look up as well as down. Warn about the presence of over-hangs, such as screens or cupboards, or jutting side mirrors of cars and trees outside. Use clear instructions and give plenty of time for the person to respond. For example, “bend your head low to avoid the tree branch coming up on your left”.
DON’T manhandle the person when providing assistance. Simply give a verbal instruction. For example, when guiding them to a seat, you could say “the back of the chair is directly in front of you and the seat is facing away from you, would you like me to guide your hand to the back of the chair?” Offer further assistance if needed. This will usually be enough and the person can seat themselves.
DO describe what’s happening around you. Be aware that the person will be disadvantaged by not seeing what is going on. So talk about what is happening. In situations that are new to us (and maybe new to you), you can help us feel more comfortable by describing what people are doing, what they are wearing, how they are gathered (in small clusters, large groups, seated at tables, standing etc.).
When sighted people are in a new (social) situation, they often copy other people’s body language and behaviour to feel more comfortable and integrated. Blind people may need some discreet help to get to know what to expect and what to do in specific, new situations.
DON’T seat the person at a table in a social situation when everyone else is standing, without first asking the person their preference. For example, at a buffet gathering, you may think it is easier to seat a person with a guide dog after collecting a plate of food. But think about how stigmatising and embarrassing that situation becomes for the individual you have isolated when everyone is standing elsewhere.
Even if they are close by, the height difference can feel like the person with sight loss is being “talked down to”. Describe the setup, where people are, and the various options, and let the person decide. Consider whether several members of the group could join the person at the table while you all eat.
DO offer to collect refreshments for the person at events where food and beverages are served. Describe what is on offer, and ask what the person would like you to do. Some people may wish to walk around a buffet table with you to hear each item on offer (particularly if they have dietary requirements), while others will ask for a selection, perhaps with specific directions, such as vegetarian only. Follow the person’s instructions, and do not select any items the person has specifically told you to exclude – doing so will cause discomfort and upset, and could be very dangerous if the person has allergies.
DON’T limit the options you give because you think explaining all those available will take too long. Consider how you would feel if this were done to you. Most people know what they want. To help the individual narrow down their choices, give a broad overview by reading menu headings or describing the main options on a table. For example: “the menu sections are pastas, salads and sandwiches”, or “the buffet table has three platters of sandwiches – one meat, one veggie and one seafood, a pasta salad, rice salad and green leaf salad, sausage rolls, crisps, a selection of cakes and some whole fresh apples and pears”.
DO tell the person when you have items to place near them, especially food or drinks. Bear in mind the person may be left-handed and /or have sight in only one eye, so let them tell you the best place for the item so they can easily and safely locate it. Tell the person if the plate or mug is hot, and which way the handle is facing. Telling the person you have liquids to place on the table is especially important if computers or other devices are on the table.
DON’T fill glasses or mugs to the brim. When a person has some sight, contrast can help the individual be more aware of how full a mug is. Black tea and coffee is more visible in a light mug, while milky drinks are more visible in a dark mug.
Lunch break at the first One Rb World Conference, London 2012.
Access and Technology
DO provide accessible signage that is large and clear enough to read, hung at eye level, and preferably tactile, with a braille alternative. Many blind and vision impaired people can navigate independently if they are given access to the same information as sighted people. But too often this information is frustratingly inaccessible, forcing dependence on others.
DON’T leave doors ajar. Close them or open them fully. Always close doors that open outwards onto a walkway, or secure them open against the wall to avoid obstructing the path. Similarly, don’t leave drawers or cupboard doors open. They are easy to walk into and can cause significant injury.
DO ensure your blind or vision impaired patient/parent, colleague or student is adequately trained on video conferencing and other online tools or apps you plan to implement. Check that the individual has an appropriate device on which these tools can be used, and can confidently use its accessibility features, including screenreading and magnification technology. It training is needed to increase the person’s skills in using accessibility features, support the individual to access this provision. This is especially important in the current work from home environment.
Have an experienced IT staffer or fellow employee do some test calls or try out new software using accessibility features, so the individual feels comfortable with the technology. Ensure all tools are accessible to the individual. If they are not, work with the person to find an alternative that is.
Also be aware that some people prefer to not use video conferencing technology. Low vision may require a person to put their head very close to the computer screen to navigate and see what is happening, which can cause great psychological discomfort when video conferencing. Offer alternative forms of communication wherever possible, and create opportunities in which your patient, colleague or student can express their concerns privately.
DON’T assume the person has assistive technology to complete tasks. While a vast array of technologies exist today, the majority have a high price tag that is beyond the means of the average person. Resources are often purchased through student disability or disability work access grants, but if the person does not qualify for these funds, they may not be able to afford the tools they need.
Always ask respectfully if you are curious about what tools the person uses, and let them show you and explain how things work – or don’t work – for them. Recognise too that discussing individual access to necessary resources can be very personal. Everyone has the right to not answer questions.
DO provide digital copies of your handouts and presentations before a meeting or conference. If a conference host requests presentations and handouts in advance to ensure accessibility for attendees, please follow their style and submission guidelines. Once you have circulated your presentation to attendees or the host, please do not significantly edit slides, and do not change the order as this causes confusion for blind and vision impaired people who are following your previous version.
At the very least, provide these materials before the presentation itself so the person can follow along using assistive technology. Receiving presentations at least several days in advance gives the person time to identify and manage any compatibility or accessibility issues, change font size and print as required, and acquaint themselves with the content so they can pay more attention to your verbal presentation on the day.
Receiving a presentation immediately before or after the event is least helpful as the person has usually missed content the speaker referred to while speaking – assuming everyone could see it on screen. Or the person is less able to pay full attention to the speaker because navigating unfamiliar content requires great attention.
Bearing this in mind, providing these materials ahead of time is a simple act of courtesy and respect, for the individual, and for yourself and your presentation.
DON’T use stylized serif fonts or poor contrast in documents, as these make reading difficult for most people with low vision, and unnecessarily strain the eye. The popular Times New Roman serif font, for example, can be tiring to read when a person has nystagmus (uncontrolled eye movement).
Clear, easy-to-read, sans serif fonts such as Ariel, Calibri and Verdana are best, with clear contrast between font and background. Ensure your “black” font is set to “automatic” in the font colour swatch, so the individual’s computer can detect and change the colour if running high contrast settings.
DO use alternative text tags to describe all images (bullet-point icons, photos, diagrams and other graphics) in every type of digital file you will share with a blind or vision impaired person, from word documents and presentations to PDFs, websites and apps. Labelling elements within apps is especially important to ensure accessible navigation. Imagine trying to navigate an app in which the trigger points are labelled “button” – you don’t know what they do or where they will take you!
How you add alt-text tags varies between software, but in most instances, you can access the tool by right-click selecting “properties” within the element you wish to tag,
When a user is navigating with a screenreader, an Alt-Tag describes the element to the user, so your alt-tag should be as clear and complete as possible. As you write the tag, it can be helpful to imagine you are describing the element to a friend on the other end of a telephone who cannot see the file.
DO apologise if an interaction goes badly, and ask the individual how you can help to make the next one go better. This almost certainly won’t be the person’s first or last awkward experience arising from their sight loss. We are all different and there is no one cookie-cutter response that fits every scenario. We value conversation, the opportunity to tell and show you what works best for us as individuals. Together, we can help smooth the path for others who will come this way after us.
Ensure resources are accessible to everyone.