CHAPTER TWO

BLINDNESS AND REHBILITTION; (an overview)

2.0 INTRODUCTION
Blindness, total or partial is the inability to see because of disease or
disorder of the eye, optic nerve, or brain. The term blindness typically
refers to vision loss that is not correctable with eyeglasses or contact
lenses. Blindness may not mean a total absence of sight, however. Some
people who are considered blind may be able to perceive slowly moving
lights or colors. (1)
The term low vision is used for moderately impaired vision. People with
low vision may have a visual impairment that affects only central vision
the area directly in front of the eyesor peripheral visionthe area to
either side of and slightly behind the eyes. Some people with low vision
are able to function with their remaining sight while others need help to
learn to use their sight more efficiently with training and special tools.
(2)
The term blindness is used somewhat misleadingly to designate certain
visual conditions. Color blindness, for example, does not reduce visual
sharpness and should more accurately be called color-perception
deficiency. Color blindness occurs almost exclusively in males, and the
most common form is the inability to differentiate between certain
shades of red and green. Night blindness, the inability to see in low
levels of light, is commonly associated with a lack of vitamin A in the
diet or with inherited diseases such as retinitis pigmentosa, a condition
involving progressive degeneration of the eyes retina and abnormal
deposits of pigment. (3)
2.I

DEFINING BLINDNESS

Vision experts assess an individual's sight using two measurements:

visual acuity and visual field. Visual acuity is the ability to see details,

such as symbols or letters of specific sizes. Normal vision is described as

20/20. A person with any degree of sight loss has a visual acuity with a
higher second number, such as 20/200. Visual field refers to the space
around the center of visionthe peripheral area. A normal visual field is
said to be 180 degrees in diameter, or half a circle. (4)
In the United States, legal blindness is defined as a person with a visual
acuity of 20/200 or less in the better eye with the best optical correction,
such as eyeglasses or contact lenses, or a visual field whose widest
diameter is no greater than 20 degrees. An individual with a visual acuity
of 20/200 must stand at 6 m (20 ft) to see objects that a person with
normal sight can see at 60 m (200 ft). An individual with a visual field of
20 degrees or less has a limited visual range sometimes referred to as
tunnel vision that is likened to viewing the world through a toilet paper
roll. A person declared legally blind in the United States is eligible for
government benefits. (5)
2.2

PREVALENCE AND INCIDENCE

Following the American analysis, about 750,000 Americans are

considered legally blind and about 50,000 new cases of blindness occur
each year. Approximately 8.9 million people have low vision. Of these,
about 1.5 million cannot read ordinary newspaper type even with the aid
of eyeglasses or other optical aids that provide significant magnification.
Although it is very difficult to determine the global prevalence of
blindness, the World Health Organization (WHO) estimates that 40 to 45
million people are blind worldwide and an additional 160 million
individuals suffer from low vision. (6)
2.3

MAJOR CAUSES OF BLINDNESS

There are three major causes of blindness in the world. These are
cataract, trachoma, and glaucoma, accounting for over 70 percent of all
cases of sightlessness.

2.3.1 CATARACT
The English dictionary defines Cataract as a disease of the eye causing
its opacity and, unless treated, leading to blindness. Cataract is an
opacity, or cloudiness, in the normally clear lens of the eye that
interferes with vision. Although regarded by many people as an
unavoidable effect of advancing age, cataract may develop at any time in
lifeeven before birth. Worldwide, cataract causes 19 million cases of
blindness. In Africa and Asia, cataract accounts for nearly half of all
blindness. Surgery to remove the opaque lens is the only effective way
of treating cataract. Worldwide, however, only 10 to 20 percent of all
cataracts are removed. (7)

Eye with cataract

2.3.2 Trachoma
Trachoma, contagious infection of the eye caused by Chlamydia
trachomatis, (a bacteria related to the organism that causes psittacosis).
Infection is spread by the bite of a host fly. Characterized by hard
pustules or granular excrescences on the inner surface of the eyelids,
inflammation of the membrane, and subsequent involvement of the
cornea, trachoma is a major cause of blindness especially in some
villages in northern Africa. It most commonly occurs among populations
living under poor sanitary conditions. (8)
The disease begins after an incubation period of five to seven days with
inflammation of the eye. Ensuing symptoms are considerable discharge
of pus, swelling of the lids, tearing, and increased sensitivity to light. It
goes on in a few weeks to chronic swelling, formation of blisters in the
eye, and destruction and scarring of the cornea, which eventually causes
blindness. In its early stages trachoma responds readily to the topical,
and sometimes oral, administration of broad-spectrum antibiotics. In the

1950s the World Health Organization instituted a broad program for

elimination of the disease. (9)
2.3.3 Glaucoma
Glaucoma, group of eye diseases characterized by increased pressure
within the eye and resulting loss of vision. Although the vision loss
caused by glaucoma is irreversible, medication or surgery can usually
control the pressure within the eye and slow or halt the progression of
the disease. If glaucoma is diagnosed in its early stages, it can be treated
effectively, and vision can usually be preserved. (10)
Glaucoma occurs in two main varieties, known as chronic simple and
acute glaucoma. (11) In chronic simple glaucoma, pressure within the
eye rises gradually, and vision loss progresses over a period of years. In
acute glaucoma, the pressure inside the eye rises suddenly and
immediate medical treatment is necessary to preserve vision. (12) Acute
glaucoma is also known as narrow-angle or angle-closure glaucoma,
because the angle between the cornea (the transparent layer of tissue at
the front of the eye) and the iris (the colored part of the eye) becomes
smaller than normal. Chronic simple glaucoma is also known as openangle glaucoma because the angle between the cornea and iris remains
normal. (13) Worldwide, approximately 6.7 million people have
significant vision loss in both eyes due to glaucoma, making this
condition
the
second
leading
cause
of
blindness.
(14)Age is a primary risk factor for glaucoma: The condition strikes
about 2 percent of people over age 40, and about 8 percent of people
over age 70. The disease tends to run in families, although it is not
inherited in a regular, predictable pattern. (15) Glaucoma affects six to
eight times as many blacks as whites, and blacks may develop glaucoma
at a younger age and suffer more severe vision loss than whites. (16)
Other factors that increase the risk of glaucoma include diabetes,
nearsightedness, high blood pressure, and long-term use of cortisone or
other steroid medication (Any medication to enhance athletic
performance). Although risk factors for the disease are well understood,
the cause of glaucoma remains unknown. (17)

2.3.4 SYMPTOMS of Glaucoma

In its early stages, glaucoma is symptomless. The gradual increase of
pressure inside the eye does not cause any pain or discomfort. As the
disease progresses, however, vision begins to deteriorate. If glaucoma is
left untreated, the field of vision continues to shrink until a person
becomes blind. (18) Glaucoma can be detected before vision loss occurs
through a simple, painless routine eye exam called tonometry test. The
instrument for this test is called tonometer. The instrument blows a
puff of air into the eye to measure the pressure inside the eye. (19)
Put together, No worldwide estimates are available on the incidence of
blindness and visual loss caused by eye injury, but some figures are
available from individual countries. In Nigeria, for example, 25 percent
of those accidentally blinded are schoolchildren. In some developing
countries, where medical care may be minimal, a slight abrasion of the
cornea often leads to ulceration, severe infection, and ultimately loss of
the eye. In all cases of visual impairment, certain percentage of eye
injuries occur on the job, in schools, and in sports and recreational
activities; yet it is estimated that 90 percent of all eye injuries could be
avoided by practicing eye safety and using protective eyewear. (20)
2.4 REHABILITATION
INTRODUCTION
The role of rehabilitation in the lives of persons with VISUAL
IMPAIRMENT cannot be IGNORED. In definition, Rehabilitation is the
act of restoring something to its original state, like the rehabilitation of
the forest that had once been cleared for use as an amusement park. It is
the process of restoring a person's ability to live and work as normally as
possible after a disabling injury or illness. It aims to help the patient
achieve maximum possible physical and psychological fitness and
regain the ability to be independent. It offers assistance with the learning
or relearning of skills needed in everyday activities, with occupational
training and guidance and with psychological readjustment. (21)

The noun rehabilitation comes from the Latin prefix re-, meaning
again and habitare, meaning make fit. When something falls in to
disrepair and needs to be restored to a better condition, it needs
rehabilitation. People seek rehabilitation after an accident or surgery to
restore their strength, or to learn to live without drugs or other addictive
substances or behaviors.(22)
Rehabilitation, term signifying any programmed ameliorative exercise,
guidance, or instruction afforded to those with a particular disability,
whether physical, psychological, or social; the term is also applied to the
economic help or relief given to refugees or victims of natural disasters,
and sometimes to urban reconstruction programs. Rehabilitation is
generally synonymous with therapy, as sponsored by official or public
programs. (23)
People who can profit from rehabilitation include convalescents, deafmutes or blind people, amputees or paralytics, emotionally disturbed
people, alcoholics, criminals, and juvenile delinquents. In all cases the
purpose of such beneficial treatment is the instilling or restitution of
positive skills or attitudes in a person to provide him or her with a more
contributive and fulfilling role in society. See Occupational Therapy;
Physical Therapy; Psychotherapy; Rehabilitation, Vocational; Therapy.
(24)
2.5 HISTORY OF REHABILITATION
The organization was set up as the Rehabilitation Institute in 1949
Dublin, Ireland to support people recovering from TB to rebuild their
lives, to regain their independence and to re-enter the workforce
following their illness. In the early years, Rehab (Rehabilitation)
focused on providing training services to support people to enter or to
re-enter the workforce.
Throughout its history, Rehab has developed considerable skills and
resources in meeting the needs of people who need specific supports to
live the lives that they want to live. Since its early years, Rehab has

expanded its focus to include all people with disabilities and others who
are marginalized and, in all, hundreds of thousands of people and their
families have benefitted from the services provided by the organization
over the years. Rehab has transformed into one of Europe's most
dynamic disability organizations. World-class facilities have been put in
place throughout Ireland and the UK along with programmes that are
often replicated across Europe. The organization has diversified
considerably, developing sustainable, commercial businesses where
people with disabilities and people without disabilities work side by
side. Today these businesses operate in a number of areas including
recycling, packaging, logistics and retail services.
In 1995, the organization moved into new areas of service provision,
providing people with disabilities and older people with health and
social care services such as day, home-based, respite, residential and
outreach services. Throughout its history, Rehab has worked hard to
ensure its economic sustainability so that it can continue to provide highquality services for the people it serves. In 1952, Rehab launched a
football pools competition as Ireland's first nationwide lottery operation.
Since then Rehab Lotteries products have evolved to include scratch
cards, radio and online bingo.
Since its inception, Rehab has been at the forefront of the campaign to
give disability its rightful place on the national agenda. As early as the
1950s, Rehab has sought to influence government policy to significantly
improve quality of life for people with disabilities. It has lobbied for the
introduction of realistic State payments to those whose disability
prevents them from working, along with measures to increase access for
people with disabilities to public transport and public buildings.
Today, there is a growing recognition that a broad coalition of all
stakeholders in the disability sector is best placed to effect real change

and that working together so much more can be achieved. Through such
a stakeholder approach, Rehab has played an instrumental role in the
development and implementation of the National Disability Strategy
which for the first time places disability firmly on the agenda of key
government departments.
Over the last 60 years, a huge amount has been achieved by Rehab for
people with disabilities. Rehab plans to build on this and to play a key
part in shaping a better future for people with disabilities and others who
are marginalized for many years to come. (25)
2.6 TYPES OF REHABILITATION
Rehabilitation programs are doctor-supervised programs designed to
assist individuals with a physical or mental condition that they may not
be able to deal with on their own. The therapists/social workers who
work in these programs treat a variety of conditions including physical
conditions, occupational limitations and narcotic abuse. Patients
participate in rehabilitation either by going to inpatient (An inpatient is a
patient who must be hospitalized for at least one night in order to receive
medical treatment)sessions for a certain amount of time or visiting the
facility on a daily basis for visits until he or she no longer needs the
therapy. There are many different types of programs and are
administered in medical facilities and by local or county agencies. (26)
2.6.1 Drug Rehabilitation Programs
Drug rehabilitation (often drug rehab or just rehab) is a term for the
processes of medical or psychotherapeutic treatment, for dependency on
psychoactive substances such as alcohol, prescription drugs, and street
drugs such as cocaine, heroin or amphetamines. (27)
Some government agencies also subsidize much of the cost of a drug
rehabilitation center visit for indigent addicts or those who have been
ordered into a drug treatment program through court order or other

involuntary arrangement. Some drug rehabilitation centers are affiliated

with local hospitals, while others work independently or are considered
non-profit organizations. (28)

2.6.2 Juvenile Rehabilitation Programs

The amount of time that a minor is involved in a juvenile rehabilitation
program can vary. Some minors are there for short periods such as
several weeks or months. Many legal systems operate under the
assumption that juvenile offenders can be rehabilitated if proper
intervention is provided, and rather than allowing juveniles to disappear
into the justice system, the courts would rather provide juveniles with an
opportunity to undergo rehabilitation which might offer them a second
chance.(29)
2.6.3 Offender Rehabilitation Programs
For first offenders convicted of driving under the influence or public
intoxication, rehabilitation programs may be offered as an alternative to
jail. (30)
2.6.4 Alcohol Rehabilitation Programs
Drug and alcohol rehabilitation programs provide rehabilitation to
people who have a chemical dependency. (31)
2.6.5 Vocational rehabilitation programs
Vocational rehabilitation is a process which enables persons with
functional, psychological, developmental, cognitive and emotional
impairments or health conditions to overcome barriers to accessing,
maintaining or returning to employment or other useful occupation.[32]
2.7 PROCESS OF REHABILITATION

Disability is an umbrella term for impairments, activity limitations, and

participation restrictions, denoting the negative aspects of the interaction
between an individual (with a health condition) and that individuals
contextual factors (environmental and personal factors) (WHO 2011;
WHO 2001). People with disabilities (PWD) therefore include those
who have long-term physical, mental, intellectual or sensory
impairments resulting from any physical or mental disability. (33)
The first step in the rehabilitation of persons with a disability is
counseling. There are various ways of counseling people with such
condition such as group counseling or individual counseling. Group
counseling is a way of bringing two or more people together to counsel
them, while individual counseling is with just one person. The essence
of this counseling is to let the person, first to be aware of his or her
current status and accept it, encourage him/her not to give up on himself
and accept rehabilitation to help re-instate and restore that person to the
way he/she was. During the counseling, stories of successful people with
similar disability will be told in order to improve the persons interest in
the rehab.(34)
The other is the rehabilitation. This is done through various means, but
for person who just got blind, it include; the use of typewriter, how to
write in Braille, the use of computer, and most of all, mobility. This will
help the person to be independent and empowered to be able to compete
with their sighted counterparts. (35)
2.8 BENEFITS OF REHABILITATION
The role of rehabilitation in the global health arena is expanding as
persons with disabilities and other stakeholders are drawing attention to
the rights and needs of the growing number of persons with disabilities.
Rehabilitation providers possess unique knowledge and skills to
optimize the care of persons with disabilities. (36)
Rehabilitation can be of significant benefit to an individual who is
experiencing a change in his or her physical abilities. Most people are
familiar with the importance of rehabilitation following surgery, injury,
or stroke. Rehabilitation addresses many of the issues and challenges
experienced by individuals with disability. Limitations in movement and
other abilities affect many other aspects of everyday life, and the

different types of therapy offered through rehabilitation work to regain,

or find ways to compensate for, lost function. Safety precautions and the
prevention of pressure sores are also vital issues that are promoted
through rehabilitation. (37)

2.9 EDUCATION OF THE VISUALY IMPAIRED

Braille Alphabet
In the Braille alphabet, each letter, number, and punctuation mark
consists of one to six raised dots. Blind people can read the characters by
feeling the arrangement of the raised dots with their fingers.(38)
Efforts to educate people who are blind are of comparatively recent date.
No records can be found of attempts to provide systematic education for
blind children in the days of antiquity or during medieval times. By the
end of the 18th century, enlightened humanitarians became convinced
that it was possible for the blind to adapt themselves to the conditions of
normal living. Valentin Hay, a French government employee, began the
pioneering work of teaching the blind in the latter half of the 18th
century, founding the first institution for the education of blind children
in Paris in 1784. Hay also taught his blind pupils to read, by touch,
raised letters embossed on paper. He not only provided school training in
formal subjects in his school, but also in music and in several trades.
(39)
Hay's work set the pattern for institutions that were later founded in
Liverpool, England, in 1790; in Vienna, Austria, in 1804; in Berlin,
Germany, in 1806; and in other European countries. Hay also

influenced the establishment of the first educational institutions for the

blind in the United States, including the Perkins School for the Blind,
formerly of Boston and located now at Watertown, Massachusetts; the
New York Institution for the Blind and today known as the New York
Institute for Special Education; and the Overbrook School for the Blind
in Philadelphia, Pennsylvania, which were established as private
philanthropic organizations. The state of Ohio established a school for
the blind in 1837, the first state institution for the education of blind
children in the United States. (40)
In 1824 Louis Braille, a French student and later teacher who was blind
himself, invented the system that enables blind persons to read. It was
based on the night writing principle of Charles Barbier, a captain in the
French cavalry, who used a combination of 12 dots that were embossed,
or pressed, into paper to allow military communications to be read at
night. Braille's system used six raised dots arranged in cells of three
rows of two. Dots were arranged in different combinations that blind
people feel with their fingertips. The patterns formed a code that spelled
out letters and numbers and symbolized concepts. (41)
Although the Braille system was published in 1829, it was not officially
accepted in the United States until 1916. During that time, Braille
advocates argued in favor of three different embossed-type systems:
English Braille, which closely followed the original French Braille;
American Braille, which assigned Braille signs to the letters of the
alphabet on the basis of how often each letter was used in the language;
and New York Point, in which dots were arranged in cells two dots high
and one to four dots long. The United States eventually accepted English
Braille as its standard. In 1932 English Braille also became the universal
system for the English-speaking world. (42)
Braille was first printed using a pointed sharp instrument that elevated
small dots on a sheet of heavy paper. A metal template that clamped over
the paper kept it secure while the dots were inscribed by hand. Printing
later was done using presses consisting of two stereotype plates, each
imprinted with the dots for the Braille text being printed. These dots had
to be hammered by hand into the plates or the plates were cast in a

custom-designed mold. In 1893 the stereotyping machine was

developed, which automated the process of transferring the dots onto the
stereotype plates. A further printing innovation was inter-point printing,
which enabled Braille to be printed on both sides of a page. It was
introduced in the United States in the 1920s. These developments made
producing Braille books faster and easier. (43)
In 1858 the American Printing House for the Blind was founded in
Louisville, Kentucky, to produce and distribute books to blind children.
In 1879 Congress permanently funded this national printing house. It
produced its first raised-print book in 1866, in which letters were
embossed on the surface of the page, and its first Braille book in 1893.
Today publications in Braille are produced using computer programs
that translate print into Braille. The files containing the Braille text are
sent to electronically driven machines that make the printing plates. (44)
Up until the 1970s, many children with visual impairments in the United
States continued to be educated only in schools for the blind. Today,
however, visually impaired children attend regular classes with their
sighted peers in both private and public schools anywhere in the world.
In part, this is due to the many technological innovations for teaching
visually impaired people. Braille can now be automated and printed
rapidly using special typewriters or word processors and Braille printers.
Students may also have access to machines that translate Braille into
speech. Audiotape recordings of book texts permit visually impaired
people to learn by listening. (45)
Computers equipped with synthetic speech systemsa sound board and
microphone for inputting spoken words and a program to translate those
words into a form the computer can useare also becoming available.
These systems are usually combined with a voice output system to
enable the user to verify that the computer has correctly interpreted the
input. These systems are faster than Braille and audiotapes for accessing
information. Another innovation is the voice output print scanner. These
systems scan a book into a computer and then convert the text into voice
outputthat is, the computer reads the material out loud in one of a
choice of voices. These devices are useful not only in the classroom, but

also in the workplace, permitting blind adults to be productive in any

job. (46)

Endnotes
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.

Thomas W. Jones, "Blindness." Microsoft Encarta 2009 [DVD]. Redmond, WA: Microsoft Corporation,
2008.
Ibid.
Ibid.
Ibid.
Ibid.
Ibid.
Ibid.
Ibid.
Ibid.
Ibid.
Doctor Benedict Onwunmere, (an optician), 42 years, in discussion with the author in his office, 20th of
May, 2015.
Ibid, Microsoft Encarta.
Ibid.
Ibid.
Ibid, doctor.
Ibid, Microsoft Encarta
Ibid, doctor Ben.
Ibid.
Ibid, Microsoft Encarta.
Ibid, doctor Ben.
WWW. roisin.fitzgerald@rehab.ie./ history of rehab, cited on 23rd March 2015
Ibid.
"Rehabilitation." Microsoft Encarta 2009 [DVD]. Redmond, WA: Microsoft Corporation, 2008.
Ibid.
ibid, history of rehab.
http://www.wisegeekhealth.com/the-different-types-of-rehabilitation-programs.htm#comments, Cited on 8,
July 2015.
https://en.wikipedia.org/wiki/Drug_rehabilitation, cited on 8 July, 2015.
Ibid, wisegeekhealth.
Ibid.
Ibid.
Ibid.
https://en.wikipedia.org/wiki/Vocational_rehabilitation.
Celia Pechak, Mary Thompson, disability and rehabilitation in developing countries (Texas Womans
University & Health Volunteers Overseas Dallas, Texas) 2007.
Miss Ikeji Amaka, ( Braille embosser operator), 33 years, in discussion with the author at the conference
room, ANWAB, 17 , 2014.
Ibid.
International Society of Physical Medicine and Rehabilitation:www.isprm.org/who, cited, 8th February,
2015.

37. Burks JS, Johnson KP, Multiple Sclerosis; Diagnosis, Medical Management, and Rehabilitation, (Demos
Medical Publishing, New York, 2000).
38. Ibid, Microsoft encarter. Reviewed by: National Eye Institute, Physical rehabilitation.
39. Ibid.
40. Ibid.
41. Ibid.
42. Ibid.
43. Ibid.
44. Ibid.
45. Ibid.
46. Ibid.