Factors Related to Braille Reading Acquisition among Aging Braille Learners: Exploring the use of Technology to Enhance Training Outcomes

Natalie Martiniello, Université de Montréal, Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, natalina.martiniello@umontreal.ca


The prevalence of older adults with acquired vision loss is expected to double by 2050 as life expectancy continues to increase, and reading difficulties remain the most common reason for referral to vision rehabilitation services. Refreshable braille technologies provide expanded access to information in braille, and may be beneficial to older adults who experience age-related declines in tactile acuity. Despite this, very little is known about the impact of aging on braille reading, how reading performance differs between hardcopy and electronic refreshable braille, or whether such technologies would improve training outcomes for older adults who pursue braille training. The goal of this research is to answer fundamental questions about aging on braille reading performance through both traditional and technological methods and to explore whether use of refreshable braille technologies within training interventions would help to better meet the unique needs of a quickly aging population.

1. Introduction and Background

The ability to read is necessary for the completion of many daily tasks and is closely tied to feelings of self-competence and independence for adults with vision loss [14, 17]. While braille is generally understood to be a crucial component of literacy for young children who are blind [12], considerably less is known about how to best meet the unique needs of older braille learners. These questions are especially pertinent as Vision Rehabilitation providers increasingly encounter older individuals who have age-related vision loss [9]. In fact, reading difficulties are among the most common reasons for referral to vision rehabilitation services [2].

What is Braille?

Braille is a tactile reading system for the blind that consists of a two-by-three matrix, with dot combinations forming letters and other symbols needed to represent written language (see Figure 1). For example, the letter c contains dots 1-4 (the top left and right dots of the braille cell).

Image of a braille cell, containing a 2x3 matrix (2 dots horizontally, 3 dots vertically), numbered 1, 2, 3 (down the left hand side), 4, 5, 6 (down the right hand side).
Figure 1. The Braille Cell.

Adult Learners

Adult braille learners present a unique challenge for two distinct reasons. First, adults inherently learn differently than children (who are typically learning braille alongside basic literacy skills [21]). Consideration of the adult learner’s self-concept, prior experience and motivation for learning is required [10], and often skills are most effectively learned by application to scenarios relevant to the learner. Practical, hands-on training for novice braille readers has historically been very difficult to provide, due to the cost and time involved in producing material in hard copy (paper) braille. The recent introduction of low-cost electronic refreshable braille displays that present text (such as what appears on a computer screen or smartphone) in a refreshable braille format [16]) will significantly alter these realities.

Second, normal aging processes introduce declines that are suspected to impact the ability to learn and efficiently read braille. Losses in cognitive functioning, such as the presence of mild cognitive impairment [22, 13] or declines in working memory capacity [1], may impede overall comprehension [18]. The inherently sequential nature of braille reading differentiates it from print reading, and working memory has a greater influence on retention of each successive symbol that is perceived and overall retention of what has been read [5, 6, 15]. Similarly, tactile sensitivity in the fingertips may be reduced with age [3, 4, 19, 20], especially if vision loss is accompanied by age-related conditions that cause neuropathy such as diabetes [7]. There is evidence that tactile acuity thresholds may be improved through training [23, 24], however, and that the use of electronic braille displays (with their crisper and more accentuated braille dots) could mitigate these concerns.

2. Statement of the Problem

There is relatively little empirical, evidence-based research available to inform the provision of braille instruction to older adult learners. Prior research (discussed above) suggests that adult learners may have greater difficulties in learning to read braille, but very few of the prior studies linking motor, cognitive, and perceptual declines with braille reading performance have been replicated extensively, if at all.

At the same time, the development of low-cost refreshable braille technologies raises new questions and opportunities in the field of braille and aging. Despite potential benefits, these technologies have been traditionally costly and adults (particularly those who are neither working nor studying) have been excluded from funding regimes, where they exist at all. The greater affordability of these devices may be especially beneficial for aging learners with reduced tactile sensitivity, and for those with dual sensory (combined vision and hearing) impairments.

Previous research has suggested that the use of braille displays as a supplementary tool during training interventions could also be motivational and improve learning outcomes, but there is little evidence-based data to confirm this hypothesis [11]. Moreover, little is known about the ways in which refreshable braille may impact braille reading performance. Traditional braille displays consist of only a single line, and there is evidence from print reading research that this limitation may impact retention and comprehension because readers develop a ‘mental map’ and recall facts read in part by their spatial location on the page [8]. With only a single line displayed at a time, the reader is provided with no equivalent spatial context.

3. Proposed Research Methodology

Two quasi-parallel studies are proposed that will explore (1) the relationship between perceptual, motor, and cognitive factors and braille reading performance, and (2) whether utilization of an electronic braille displays during the braille learning process will improve learning outcomes.

The correlation studies will assess the cognitive functioning, tactile working memory, motor dexterity, tactile discrimination thresholds, reading speed and reading comprehension of a sample of at least 50 adult braille readers. Pearson correlation coefficients will be calculated between predictor variables to identify and remove redundant variables (>.90) from the proposed model. A linear regression for outcome variables will be performed with the most highly correlated predictors entered into the equation first with additional variables added in decreasing order according to correlation size. Variables which do not yield significant results will be removed from the model. Through this process, we will attempt to hone in on those factors (previously signalled as potentially relevant to braille reading performance) that have a measurable impact.

The training intervention study will explore whether the use of an electronic braille display during braille instruction will positively influence their learning outcomes and reading performance. This study is based on a 2x3 mixed between-within-groups ANCOVA design (media: hardcopy/refreshable braille; time: before/during/after training). Age will be controlled as a covariate. The first group will utilize only hardcopy braille to learn the braille code throughout their training, while the second group will systematically alternate between hardcopy and refreshable braille throughout their training. The data will be plotted throughout the collection phase to observe the existence of outliers to ensure that findings are robust and that variability is well understood. At a minimum, t-tests will be used at key measurement points to ascertain whether differences exist between the groups on these measures. More advanced longitudinal analytics will be considered for assessing differences in the rate of progression between the two groups.

4. Status of Research and Next Steps

A scoping review was completed to synthesize existing research on braille reading and aging, to identify factors potentially weighing on braille reading performance. A qualitative, phenomenological study is underway to tease out extraneous facilitators and barriers that may influence the braille learning process. A New Initiatives Grant from the Centre for Interdisciplinary Research in Rehabilitation (CRIR) has been secured to launch a pilot phase of the correlation studies and final approvals are being sought to begin participant recruitment. It is anticipated that data collection for the pilot phase and the correlation studies themselves will begin during the winter of 2019.

5. Contribution to the Community

It is anticipated that this research will provide much-needed evidence upon which decisions about the use of braille display technologies in braille instruction for adult learners can be based.

Consortium Goals and Expectations

The Doctoral Consortium affords an important opportunity for this research proposal to be considered by those who have significant experience conducting research on disability, aging and assistive technology. This consortium will afford me with an opportunity to establish connections with others in the field and to strengthen my own research proposal. I am especially keen to bridge the gap between research and practice, and to gain valuable feedback from fellow students, persons with disabilities and researchers in the field of aging, blindness and assistive technology.


The author would like to acknowledge the support of the Fonds de recherche sante du Québec (FRQS) and CNIB (Ross Purse Doctoral Fellowship) in partially funding her doctoral research work, supervised by Walter Wittich, PhD at the Université de Montréal.


  1. K.L. Bopp and P. Verhaeghen. 2005. Aging and verbal memory span: A meta-analysis. Journal of Gerentology, 60B, 5, P223-P233.
  2. T. Brussee, R.M. van Nispen and G.H. van Rens. 2014. Measurement properties of continuous text reading. Ophthalmic and Physiological Optics, 34, 636-657.
  3. D. Goldreich and I. M. Kanics, 2003. Tactile acuity is enhanced in blindness. The Journal of Neuroscience, 23, 8, 3439-3445.
  4. D. Goldreich and I. M. Kanics. 2006. Performance of blind and sighted humans on a tactile grating detection task. Perception & Psychophysics, 68, 8, pp. 1363-1371.
  5. A. D. Hall and S. E. Newman. 1987. Braille learning: Relative importance of seven variables. Applied Cognitive Psychology, 1, 133-141.
  6. C.K. Hannan. 2006. Review of research: Neuroscience and the impact of brain plasticity on braille reading. Journal of Visual Impairment & Blindness, 100, 2.
  7. M.A. Heller, E. Gentaz. 2014. Psychology of Touch and Blindness, C9. iBooks Ed. New York, Psychology Press, Taylor & Francis Group.
  8. J. Hou, J. Rashid and K. M. Lee. 2017. Cognitive map or medium materiality? Reading on paper and screen. Computers in Human Behavior, 67, 84-94.
  9. A. Hudspath, J. Schwartz, S. Siegelbaum, E. Kandel and T. Jessell. 2013. Principles of Neural Science, 5th Ed. McGraw-Hill Education.
  10. M. S. Knowles, E. F. Holton III and R. A. Swanson, 2015. The Adult Learner: The definitive classic in adult education and human resource development, 8th Ed. Routledge.
  11. N. Martiniello and W. Wittich. 2018 (in press). The perception and use of technology within braille instruction: A preliminary study of braille teaching professionals. British Journal of Visual Impairment.
  12. M.P. Munro and H.R. Munro. 2013. Infusion of Print Literacy Methodology into Braille Instruction for Students with Visual Impairments. Journal of Blindness Innovation and Research.
  13. R. C. Petersen. 2011. Mild cognitive impairment. The New England Journal of Medicine, 364, 2227-2234.
  14. P.E. Ponchilllia and S.V. Ponchillia. 1996. Foundations of Rehabilitation Teaching with Persons Who Are Blind or Visually Impaired. New York, American Foundation for the Blind, 1996.
  15. E. Rex, A. Koenig, D. Wormsley and R. Baker, 1995. Foundations of Braille Literacy, 2nd ed. New York, American Foundation for the Blind.
  16. A. Russomanno, S. O'Modhrain, R. B. Gillespie and M. W. M. Rodger. 2015. Refreshing refreshable braille displays. IEEE Transactions on Haptics, 8, 3, 287-297.
  17. F. Schroeder, 1996. Perceptions of braille usage by legally blind adults. Journal of Visual Impairment & Blindness, 90, 3, 210-218.
  18. H. W. Sesma, E. M. Mahone, T. Levine, S. H. Eason and L. E. Cutting. 2009. The contribution of executive skills to reading comprehension. Child Neuropsychology, 15, 3, 232-246.
  19. J. C. Stevens, E. Foulke and M. Q. Patterson. 1996. Tactile acuity, aging, and braille reading in long-term blindness. Journal of Experimental Psychology: Applied, 2, 2, 91-106.
  20. J.C. Stevens. 1992. Aging and spatial acuity of touch. Journal of Gerontology, 47, 1, 35-40.
  21. M. Tobin and E. Hill, 2015. Is literacy for blind people under threat? Does braille have a future? British Journal of Visual Impairment, 33, 3, 239-250.
  22. W. Wittich and C. Nadon, 2015. The Purdue Pegboard Test: Normative data for older adults with low vision. Disability and Rehabilitation: Assistive Technology.
  23. M. Wong, V. Gnanakumaran and D. Goldreich. 2011. Tactile spatial acuity enhancement in blindness: Evidence for experience-dependent mechanisms. The Journal of Neuroscience, 31, 19, 7028-7037.
  24. M. Wong, R. M. Peters and D. Goldreich. 2013. A physical constraint on perceptual learning: Tactile spatial acuity improves with training to a limit set by finger size. The Journal of Neuroscience, 33, 22, 9345-9352.

About the Author

Natalie Martiniello is a Ph.D Candidate in the Vision Science program (Visual Impairment & Rehabilitation option) at the University of Montreal, supervised by Dr. Walter Wittich. Her research focuses on the impact of aging on braille reading performance, and the influence of refreshable braille technologies on training outcomes. She obtained her M.Sc (also in Vision Science) from the University of Montreal, and a B.A. in English and Educational Studies from McGill University. Prior to beginning her doctoral degree, she worked as a Certified Vision Rehabilitation Therapist, providing braille and assistive technology training to children, adults and seniors with visual impairment.