United States Department of Veterans Affairs
Blind Rehabilitation Service

History of Blind Rehabilitation Service

 

Legacy of Excellence

For more than five decades, the leadership, programs, and principles established within VA Blind Rehabilitation have contributed significantly to raising the level of quality services for the blind in the United States and abroad. It has been through the VA's pioneering and sustained efforts in research, education, and training that many innovative advances have been realized.

Much of the methodology currently being utilized in the field of blind rehabilitation can be directly traced to the experiences of Russ Williams as he learned to cope with his own traumatic loss of sight and as he attempted to utilize the assistive techniques being taught to him by other individuals. An immense amount credit should also be given to the early pioneers at Hines, who further refined the techniques taught to them by Williams, and who developed a sequential learning experience built on little blocks of success until the patient ultimately achieved his established goals.

The Hines experience created an atmosphere of respect for what blind people could do. It respect earned from outside observers watching the blinded Veterans perform newly learned skills. It was a respect from new patients beginning their BRC training program toward the seasoned patients demonstrating their newly learned skills. Finally, it was an internal respect acquired by the individual patient, himself, as he began to accomplish tasks that he never dreamed were attainable.

To their credit, the Hines Blind Rehabilitation staff was largely responsible for instilling this respect as they, themselves, were the true believers. They believed in their techniques and teaching methods. They maintained high expectations for those who participated in the rehabilitation program. They firmly believed that the blinded veteran could successfully be reintegrated into the family unit and the community at large. Not only did the Hines staff convey this belief to their patients but, ultimately, they would pass this conviction on to the graduate school programs and the future generation of blind rehabilitation specialists.


Army Programs and the VA's New Mission

On January 8, 1944, President Franklin D. Roosevelt made an extraordinary commitment to our nation's war-blinded servicemen when he signed an executive order declaring: "No blinded servicemen from WW II would be returned to their homes without adequate training to meet the problems of necessity imposed upon them by their blindness."

In order to meet the demands of this obligation, it was determined that the social adjustment training of blinded soldiers would become the military's duty whereas the Veterans Administration (VA) would assume responsibility for any vocational training. A three-phase program was subsequently developed.

The initial phase called for the Army Medical Corps to provide basic blind rehabilitation instruction to newly blinded servicemen at Valley Forge General Hospital in Phoenixville, PA and Dibble General Hospital in Menlo Park, CA. Although 80% of the blinded soldiers had no sight at all and had a great need for rehabilitation training, it was clearly understood that time would not permit a comprehensive process to occur at these facilities because their primary mission focused on surgery and health recovery.

The skill training that did take place included teaching introductory techniques in Braille, typing, writing, and "orientation". "Orientation" (or independent travel) was initially accomplished using a cross-body protective technique until Richard Hoover introduced his newly designed long cane at Valley Forge in June 1945. Hoover would also develop a methodology for using the long cane as a navigational tool and blinded soldiers soon learned to appreciate the respectability and safety afforded by using this device as a travel aid in conjunction with a scanning technique.

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Legacy of Excellence

For more than five decades, the leadership, programs, and principles established within VA Blind Rehabilitation have contributed significantly to raising the level of quality services for the blind in the United States and abroad. It has been through the VA's pioneering and sustained efforts in research, education, and training that many innovative advances have been realized.

Much of the methodology currently being utilized in the field of blind rehabilitation can be directly traced to the experiences of Russ Williams as he learned to cope with his own traumatic loss of sight and as he attempted to utilize the assistive techniques being taught to him by other individuals. An immense amount credit should also be given to the early pioneers at Hines, who further refined the techniques taught to them by Williams, and who developed a sequential learning experience built on little blocks of success until the patient ultimately achieved his established goals.

The Hines experience created an atmosphere of respect for what blind people could do. It respect earned from outside observers watching the blinded Veterans perform newly learned skills. It was a respect from new patients beginning their BRC training program toward the seasoned patients demonstrating their newly learned skills. Finally, it was an internal respect acquired by the individual patient, himself, as he began to accomplish tasks that he never dreamed were attainable.

To their credit, the Hines Blind Rehabilitation staff was largely responsible for instilling this respect as they, themselves, were the true believers. They believed in their techniques and teaching methods. They maintained high expectations for those who participated in the rehabilitation program. They firmly believed that the blinded veteran could successfully be reintegrated into the family unit and the community at large. Not only did the Hines staff convey this belief to their patients but, ultimately, they would pass this conviction on to the graduate school programs and the future generation of blind rehabilitation specialists.


Establishment of First BRC

C. Warren Bledsoe’s efforts to develop a VA program met with significant challenges. Complicating matters was an agreement within VA that the Department of Medicine and Surgery would be responsible for World War I Veterans whereas the Vocational Rehabilitation and Education Service would be responsible for World War II Veterans.

Bledsoe knew that what was truly needed was a rehabilitation center, but his idea met opposition by parties within and outside the VA, who were more interested in channeling blinded Veterans into civilian programs. Moreover, VA administrators retained negative feelings about setting up a center due to their experience with the Evergreen program, which had been established in Baltimore following World War I. VA felt that the Evergreen program had kept people too long and was, therefore, too expensive.

Another factor working against the center concept was the prevailing social work point of view, which opposed any type of program that took clients away from their home. It was believed that having a central habitation for training of the blind would inevitably become paternalistic; thus such a notion should be avoided like the plague.

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The Hines Program Begins

Bledsoe’s next action was to appoint a Chief for the new Blind Rehabilitation Center. Russell C. Williams, a blinded World War II veteran, was selected to be the first Chief of the Hines Blind Rehabilitation Center. Williams had been serving as a counselor for blinded soldiers at Valley Forge, and had also participated in both blind rehabilitation training programs at Valley Forge and Avon Old Farms. Bledsoe described Williams as follows:

“If Russ had not been the person he was, there would have been no Federal program for the War Blinded worthy of the name after 1949. Seldom has the likeability of a man so kindly and astutely devoted itself to wheedling fellow human beings away from foolishness of various kinds. A sort of moral wizardry with which he is endowed was to be the fundamental stuff out of which the Hines program was to be made."

Kay Gruber was then enlisted as a consultant to assist Williams in selecting and training instructors for the proposed nine-bed unit. Harry Sparr, from the Industrial Home for the Blind in Brooklyn, NY, was the second consultant brought in to develop the industrial aspects of the program. The third consultant, Richard Hoover from the Valley Forge staff, was brought in to help train the newly selected "Orientors" in his cane techniques.

Bledsoe and Williams were convinced that the corrective therapists at Hines seemed to be the most suitable for the "Orientor" role due to their physical education background and their knowledge of kinesiology, anatomy, posture and gait. Besides, they had experience in working with other disabled war veterans and appeared to meet the basic qualifications of "common sense and durability". Williams would go on to note that he looked for: "sincere, healthy minded, emotionally balanced persons, with varied interests and sufficient security to respect their fellow workmen and the patients with whom they would come in contact". He wanted staff members who communicated with ease, were loyal to their job, and committed. Those chosen included Alfred Dee Corbett, Edward Mees, Joseph Romanko, Stanley Suterko, and Edward (Bud) Thuis.

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The Korean Conflict

The nature of combat in the Korean Conflict resulted in numerous instances of blindness and multiple handicaps.  More than 500 Servicemen were blinded during the Korean War accounting for five percent of all casualties, the highest ratio of any American battle up to that time.  In addition, there was a substantial increase in the number of disabled Veterans with bilateral hand amputations, unilateral arm amputations, unilateral and bilateral leg amputations, neurologically impairment, and brain injuries.

As a result, the VA authorized Hines to increase the BRC staff size to 32 and increase the Blind Center's bed capacity from 9 to 27.  In addition, a 13 bed preliminary unit was placed on the Ophthalmology ward for recently blinded veterans needing definitive medical care prior to participating in the regular BRC program. Many new adaptive training techniques and prosthetic devices were created during this period in order to meet the needs of disabled Veterans and the Hines staff was continually refining the long cane concept espoused by Hoover.  This eventually led to the development of a structured approach to teaching independent travel skills for the blind.

After the Korean Conflict ended, the number of applications for training at the Hines BRC began to decrease sharply.  The Hines BRC program only averaged 17 patients between 1957 through 1961.  A major contributing factor to the decrease was due to the Blinded Veterans Association field representative program sharp decreased presence due to a lack of funds.  These "ambassadors of good will" were hired to help Veterans who were overwhelmed by their blindness.  They would serve as "role models" by demonstrating the ability to independently travel to blinded Veterans homes across the country and, as a result, they essentially became the advertising wing for the VA's blind rehabilitation program.  While fully operational, these six individuals contacted some two thousand blind Veterans over the course of a ten-year period and persuaded many to apply for the adjustment training program at Hines.


Blind Rehabilitation Center Program Expansion

The Hines BRC would eventually decrease its capacity to a 20-bed unit; however, a combination of events would subsequently lead to a steady expansion of VA's residential blind rehabilitation program. The Vietnam War, combined with the earlier inclusion of allowing non-service connected Veterans eligible for training, had a major impact. Beginning in 1967, VA created the Visual Impairment Service Teams (VIST). The Visual Impairment Service Teams essentially became VA’s marketing section for the blind rehabilitation program. The VIS Teams were charged with the responsibility of coordinating outpatient services for eligible blinded Veterans and they would serve as the VA's frontline diagnostic and treatment agents for blindness.

The VIST program was subsequently strengthened when VA began establishing full-time VIST Coordinator positions in order to meet the additional demands being created by an aging Veteran population. As a result, VA and non-VA professional staff gradually became more aware of the benefits derived from Veteran participation in the VIST and Blind Rehabilitation Center programs. Ultimately, 92 full-time VIST Coordinator positions were created by VA. The outcome has been dramatic. The current number of identified blindness cases in the Veteran population now exceeds 33,000 as compared to the 5,500 blinded Veterans on VIST rosters in 1972. Consequently, this tremendous increase in case identification led to a greater demand for blind rehabilitation training.

Nine additional Blind Rehabilitation Centers have been established. Each Blind Rehabilitation Center is strategically located within the VA system in order to meet the growing demand for blind and low vision rehabilitation. The sites include:

  • Palo Alto, CA (established in 1967)
  • West Haven, CT (established in 1969)
  • American Lake, WA (established in 1971)
  • Waco, TX (established in 1974)
  • Birmingham, AL (established in 1982)
  • San Juan, Puerto Rico (established in 1990)
  • Tucson, AZ (established in 1994)
  • Augusta, GA (established in 1996)
  • West Palm Beach, FL (established in 2000)

As the number of VA Blind Rehabilitation Centers expanded, so did the number of accomplishments and innovations. New adaptive training techniques and prosthetic devices were developed to meet the needs of Veterans with multiple disabilities due to the Korean and Vietnam conflicts. Research has fostered advances in electronic travel aids, reading machines, low-vision devices, and computer access equipment.

The multi-disciplinary team approach to treatment now includes a physician, nurse, optometrist, dietitian, social worker, and psychologist in addition to the blind rehabilitation specialists. Regardless of discipline, all team members focus their efforts on promoting health, developing skills of independence, and improving adjustment to sight loss with the goal of successfully re-integrating the blinded Veteran back into the family and community environment.

Today, VA has over 200 beds committed to the Blind Rehabilitation Center instructional program and is staffed by more than 300 blind rehabilitation specialists and support personnel. VA is continually enhancing and expanding its blind rehabilitation programs to meet the needs of an aging Veteran population, as well as meet the needs of new Veterans and Servicemembers returning from the current conflicts.


Visual Impairment Service Teams and Outpatient Specialists

The first VA follow-up study of World War II Veterans occurred between 1952 and 1953 when social workers in 70 regional offices conducted structured interviews with 2,000 blinded Veterans. The demographic and social data accumulated in the interviews were set forth in a book edited by Bledsoe, War-Blinded Veterans in a Post-War Setting, issued by VA in 1958. Criteria used to evaluate adjustment and acceptance into society included: marital status, family structure, home ownership, employment, social activities, attitudes to self, and attitudes toward society. The findings amply supported the conclusion that rehabilitation training "paid dividends, both psychologically and economically".

Ten years later a follow-up study noted that half of the blinded Veterans studied had not had an eye examination within the past five years. In addition, a substantial number had a hearing loss and even more were neglecting a variety of other health problems. These findings helped jolt into existence an outreach program that Russ Williams, who left Hines in 1959 to replace Bledsoe in VA Central Office, had been urging VA to consider. It would be called the Visual Impairment Service Team (VIST) program.

In 1967, Visual Impairment Service Teams were established at 71 VA facilities and the names of all Veterans receiving disability compensation or pension for any degree of visual impairment were sent to regional VA Outpatient Clinics. Instructions were given to each facility to make personal contact with each blinded veteran in their jurisdiction and arrange for periodic reviews of their medical condition and needs. A social worker would serve as coordinator of the multidisciplinary team and enlist other appropriate personnel as needed. The VIS Team would be chaired by a physician.

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University Training Programs

In the 1950's, blinded Veterans, who had been discharged from the Hines BRC program, caught the attention of professionals in the blind services community impressing them with their confident, independent mobility skills.  This prompted the American Foundation for the Blind to enlist mobility instructors from Hines to teach their methods and concepts to teachers of the blind at summer workshops held at various colleges and universities. In addition, many private and public agencies for the blind began sending their staff members to Hines to learn the orientation and mobility training techniques. The demand for trained mobility instructors was created and led to the development of university training programs.

In 1959, the American Foundation for the Blind hosted a meeting to discuss the need to establish university training programs for blind rehabilitation instructors.  Both C. Warren Bledsoe, who had moved to the Department of Health, Education and Welfare, and Russ Williams, who had replaced Bledsoe in VA Central Office, participated in the meeting.  For his part, Williams pushed for a graduate level program stating that blind rehabilitation instructors would need to be viewed as the rehabilitation equivalents to physicians and other professionals they would be working with in order to inspire the confidence considered necessary to attract referrals from these sources.

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