COVID ‐19 and Visual Disability: Can't Look and Now Don't Touch

The coronavirus disease 19 (COVID-19) pandemic has created cataclysmic repercussions in virtually every facet of life and has had profound effects on the practice of medicine. This is particularly true for providers who treat disability. Although all disabilities are unquestionably challenged in undue ways, this perspective is meant to draw special attention to those with visual impairment. COVID-19 is extremely contagious and has spread globally with unprecedented rapidity. The best current countermeasures include personal protective equipment (PPE), social distancing, and minimizing or avoiding touch or contact with surfaces and/or objects that may be contaminated with viral particles, all of which pose unique challenges for those with low or no vision. Co-authors Rizzo and Giudice, themselves visually impaired, are researchers who are investigating creative innovation to combat the untoward consequences of visual impairment, However, this situation transcends their professional interests, as it has directly affected their lives and the lives of other blind individuals close to them. This essay builds on the combination of their personal experiences and research expertise to motivate the current problem and pose some viable solutions. When you cannot see what is around you, touch becomes the primary mode of both exploring and interacting with the environment. We rely on touch to support many tasks throughout the day, whether it be the movement of the keys as we type on our computer, the warmth and heft we feel as we pick up our morning mug of coffee, or the texture of our clothes. However, for blind and visually impaired (BVI) people, the sense of touch and use of haptics (ie, information that is perceived through active touch) transcends these “normal” uses of this modality. For this community, touch perception supports many of the same tasks that sighted people perform on the basis of visual perception. Although hearing and touch represent the principal modes of nonvisual sensing, touch and vision share the ability to accurately convey spatial information. Despite touch having a much smaller “tactile field of view” and lower sensory bandwidth capacity than vision, a growing body of evidence suggests that spatial information learned from both modalities develops into an amodal “spatial image” in the brain that functions equivalently in the service of action, irrespective of the input source. This functional equivalence (ie, statistically indistinguishable performance) between touch and vision has been demonstrated for a broad range of spatial behaviors. Neuroscientific evidence also corroborates this notion because the same expert processing region of the brain, the parahippocampal place area (PPA), has been found to be preferentially involved during functional magnetic resonance imaging (fMRI) in the computation of spatial layouts learned through haptic and visual perception. This study also found no difference in the pattern of neural activation between blind and sighted participants on the haptic tasks, which agrees with other neuroimaging research studying haptic spatial processing in “expert” brain regions between blind and sighted participants. In aggregate, the evidence showing similarity of behavior after haptic and visual learning and common neural networks underlying spatial computations between blind and sighted individuals provides converging support for the similarity of these senses in the encoding and processing of spatial information, irrespective of visual experience. One may think of spatial information as the “common denominator” of the senses, with haptic and visual inputs informing us about a common physical space (ie, our perception of the surrounding world). PM R 13 (2021) 415–421 www.pmrjournal.org