Effects of a Disability Simulation Activity on the Achievement,Efficacy,Attitudes,and Interests of Preservice Professionals

Abstract

Introduction: Disability simulation activities are commonly used for various purposes in higher education; however, instructors may be unaware of controversies regarding their use. The purpose of this research was to assess the effects of an activity using low vision goggles to simulate visual impairment in the context of an undergraduate course in special education. We highlight the need for instructors to consider the appropriateness of disability simulation activities given possible countertherapeutic effects. Methods: In this cluster-randomized trial, 11 classes (248 students) of preservice education and related services professionals were randomized to experimental (lecture + simulation) or control (lecture only) conditions. During a single class session, all students received basic information about visual impairment and watched a video on being a human guide. Students in the experimental group then practiced guiding and being guided while wearing low vision goggles. At the end of class, students completed three Likert-type surveys and later completed a quiz using publisher-developed materials. Results: Results showed individuals in the experimental group reported higher levels of interest and enjoyment than those in the control condition; however, there were no statistically significant differences in attitudes toward persons with visual impairments, confidence or self-efficacy for working with students with visual impairments, content knowledge, or perceptions of activity usefulness. Discussion: Findings of positive engagement in the absence of harmful effects indicate that disability simulation activities should be neither promoted nor denigrated wholesale; instead, instructors must weigh carefully potential benefits and drawbacks. Discussion includes considerations for professional education programs in using such simulations to promote skill acquisition via positive and respectful learning experiences. Implications for practitioners: Instructors who use disability simulation activities are encouraged to consider whether to discontinue this practice or incorporate principles recommended by the disability community and assess outcomes to ensure they are not perpetuating harmful stereotypes.

Keywords

disability simulation activities special education and related services preservice teacher education professional preparation and training visual impairment

In special education and related fields, disability simulation activities have long been common features of introductory-level courses in teacher and professional preparation degree programs (Orlansky, 1979). The popularity of these activities may stem from pedagogical perspectives that encourage active learning, a framework that promotes constructing meaning through socially mediated and physically engaging activities rather than passively listening to lectures given by a content expert. In contrast to courses within programs specific to teaching students with visual impairments (e.g., blindfold and simulation cane courses used in programs to train orientation and mobility specialists; Griffin-Shirley, Bozeman, Obiero, Steinle, & Page, 2019), the types of disability simulation activities referenced here are brief, often decontextualized activities conducted in general education, special education, or other social sciences courses. In such simulations, students briefly role-play experiences of individuals with disabilities by artificially imposing a physical limitation such as using a wheelchair to simulate paraplegia or hearing aids to imitate hearing loss. Usually, the participant is then asked to perform a task such as navigating a public space.

Although these activities are widely presumed to improve participants’ attitudes toward and empathy for people with disabilities by allowing them to experience to some small degree the barriers encountered by people with disabilities on a daily basis, such assumptions may be misguided and often go untested. Though well-intended, it is likely that instructors who conduct such activities are unaware that many in the disability community have serious concerns about both the ethics (Lalvani & Broderick, 2013; Valle & Connor, 2011) and the effectiveness (Flower, Burns, & Bottsford-Miller, 2007) of disability simulation activities. For example, recent studies have shown that “one shot” experiences commonly held on college campuses outside of students’ regular coursework or, as one author put it, “crip' for a day” (Nario-Redmond, Gospodinov, & Cobb, 2017) activities, have produced negative emotions and attitudes toward individuals with disabilities. As Silverman (2017) explained, such studies represent

the traditional type of disability simulation, which thrusts people into disability without any training in alternative techniques or changeable environmental barriers. Such simulations are designed to produce fear and distress to play up the plight of disability. As the above research suggests, they do a good job of that (para 5).

As a counterpoint to the above research, Silverman et al. (2017) incorporated instruction in activities of daily living to create a disability simulation activities that improved attitudes toward people with disabilities in a group of occupational and physical therapy students. Similarly, Colwell (2012) demonstrated improved attitudes following such simulations embedded in coursework for preservice music therapists and educators.

It is important to bring attention to these issues and provide instructors with information on which to base instructional decisions. Thus, the purpose of the current study was to assess the effects of an occluded vision (visual impairment; i.e., blindness or low vision) simulation on participants’ achievement and self-reported self-efficacy for teaching students with visual impairments, attitudes toward individuals with visual impairments, knowledge of course material, and interest and enjoyment of the activity itself. The activity represented aspects of disability simulation activities that are commonly used in college classrooms across disciplines related to elementary and secondary (kindergarden-12th grade; K-12) education and rehabilitation and was designed following recommendations from individuals with disabilities. Specifically, students were taught to act as human (and in this case, sighted) guides so that the emphasis of the activity was on learning adaptive skills.

Theoretical perspectives and practical implications

Traditional medical models of disability focus on physical manifestations and limitations, whereas the more modern social model focuses on negative social attitudes and stigmatization as barriers to adaptive functioning that may be as disabling as a physical limitation (Barney, 2012; Behler, 1993). These differences in perspectives have contributed to differences in the purpose, procedures, outcomes, and interpretations of research on disability simulation activities. Whereas some researchers and advocates have interpreted previous negative findings as evidence that such simulations are entirely devoid of merit and should be proscribed by all, others have suggested ways to implement simulations in an ethical manner to avoid harmful effects. Notably, several such articles (Barney, 2012; Behler, 1993; Burgstahler & Doe, 2004; Singer, 2016; Silverman et al., 2017) have been written by individuals with disabilities and explicitly suggest practical methods for implementing disability simulation activities rather than abandoning them altogether. Drawing from these sources, we identified recommendations for conducting such simulations (Table 1) and developed study procedures accordingly.

Table 1.

Overview of DSA components and study procedures.

Timing	General recommendation	Study procedures
Before (10–15 minutes)	Provide context	Explain purpose and objectives: to teach ways of communicating and interacting with individuals with VI; to develop appreciation for physical and social barriers to successful interactions and think about ways to reduce those barriers
	Activate background knowledge	Review terms, types and levels of visual impairment (e.g., acuity, field of vision, visual impairment, legally/functionally blind); connected to students’ prior experience
	Provide positive examples of individuals with visual impairment or blindness in activities of daily living	Show videos of individuals who are blind successfully completing activities of daily living; point out learned adaptive techniques
	Avoid coercion	Explain that participation is voluntary; highlighted the activity is intended to be fun, challenging, and thought-provoking; allow students to determine the level of visual impairment by choosing lenses in the goggles or opt out entirely
	Provide detailed directions for completing the activity	Show a video on how to be a human guide; give instruction on ways to communicate effectively and ensure one another’s physical and emotional safety; review written instructions for completing the task and check for understanding
During (15–20 minutes)	Engage in active supervision	Monitor to assess students’ comfort levels and provide feedback to ensure students follow safety procedures; where necessary, suggest ways human guides could provide support while promoting participants’ independence
During (15–20 minutes)	Create an engaging and enjoyable activity	Allow students to self-select partners and time spent in each role; include a variety of tasks (navigation, personal hygiene, using utensils, and providing a choice of edible reinforcers)
After (8–10 minutes)	Debrief	Discuss positive and negative experiences in guiding and being guided. Acknowledge and discuss sources of possible physical or emotional discomfort in terms of course objectives; discuss barriers to inclusion and potential solutions

Note. Above recommendations were derived from Barney, 2012; Behler, 1993; Burgstahler & Doe, 2004; Singer, 2016; Silverman et al., 2017.

Summary and research questions

Little high-quality experimental research has been conducted on disability simulation activities, but the few studies analyzing simulations with college undergraduates have produced mixed results. Given the widespread use of such simulations in professional preparation courses, it is important to evaluate whether or not this common practice should be abandoned. Therefore, the purpose of the current study was to conduct a rigorous experiment assessing the effects of disability simulation activities in an introductory undergraduate course. The visual impairment simulation activity was designed to maximize students’ positive experiences and teach useful skills for interacting with people with impaired vision: the human guide technique. The primary research question was: Are there significant differences between groups of students randomly assigned to experimental (lecture + simulation) or control (lecture only) conditions in measures of achievement, efficacy, attitudes, or interest? Given prior low effect sizes and mixed results (Flower et al., 2007), our hypotheses were nondirectional.

Method

Participants and setting

Participants were 247 undergraduates (80% female) enrolled in 11 sections of an introductory special education course during fall and spring of the 2017–2018 school year. Each section was taught by one of seven instructors: four full-time faculty members (including the first two authors) and three part-time (adjunct) instructors. Collectively, the instructors had between 5–28 years of experience as K-12 special educators and six had taught the course in previous years. None had extensive experience teaching individuals with visual impairments.

The course, entitled, "Special Education in Contemporary Society," was designed primarily for students who were enrolled in the college of education and human services at a large state university in the Appalachian region of the United States and was required for most students. This 3-credit course met once for 3 hours each week for 16 weeks and followed the general format of 2–3 weeks of special education foundations followed by a chapter on each of the 13 disability categories identified by the Individuals with Disabilities Education Act (IDEA, 2004). Majors were categorized as degrees in (a) general education, or teaching students without disabilities (e.g., elementary, secondary, early childhood, physical, art, or music education; n = 143); (b) special education or related services for individuals with disabilities (e.g., disability studies, speech-language pathology, or occupational therapy; n = 40); or (c) other degree programs (n = 62). This third category included students who were enrolled in child development and family studies, multidisciplinary studies, and music therapy, as well as those who had declared majors in the college of liberal arts (e.g., English and psychology) or medicine (e.g., nursing and exercise physiology) but were adding an education minor or considering transferring to the college of education. Five class sections were randomly assigned to the traditional lecture-only (control) condition and six were randomized to the lecture plus disability simulation activity (experimental) condition. There were no significant differences in gender (x² = 2.35; p = .13) or major (x² = 0.51; p = .78) between experimental and control groups.

Procedures

One or both of the first two authors attended each of the classes on visual impairment typically in week 11 or 12 of a 16-week semester. In all classes, the instructors of record were asked to deliver their typical lessons on visual impairment per their usual methods with no restriction on duration or content. Instructors commonly used publisher-produced materials (Gargiulo & Bouck, 2017), supplemental videos, lectures, and discussions. In classes randomized to the control condition, one or both of the first two authors informed students about the study, obtained signed consent forms, and administered the survey instruments described below immediately following the traditional lesson. Students completed individual surveys anonymously per protocols approved by the university's institutional review board. In classes randomized to the experimental condition, the authors guided students in low vision simulation activities immediately following the traditional lesson, and then administered survey instruments immediately following the disability simulation activity.

The activity was designed according to best practices for introducing, implementing, and debriefing disability simulation activities (Table 1). First, the authors introduced the purpose of the simulation, gave directions, drew attention to safety concerns, checked for understanding, and stated that participation was voluntary. During the introduction, students learned to support individuals with visual impairments including ways to improve communication, basic orientation and mobility skills, and how to be a human guide. They watched videos of individuals with blindness successfully completing daily tasks such as cooking and navigating different environments. The introduction also included a video explaining how to be a guide for a person with visual impairment. Next, the researchers explained the simulation activity in which student dyads would take turns being a guide or being guided and completing a series of tasks in the classroom and around the building.

To simulate visual impairment, students being guided wore Zimmerman low vision goggles with 11 interchangeable lenses and funnels that simulate different degrees of central and peripheral vision loss. Examples of simulated visual impairment included macular degeneration for both near and distance viewing, cataract, scotoma, hemianopia, and total blindness. Students self-selected the type and level of visual impairment by choosing the type of lenses in the goggles they wore (i.e., degree of restricted occlusion, acuity, and field of vision). They also self-selected activity partners. Student pairs were instructed to travel throughout the building, including using stairs and elevators, before washing their hands and returning to the classroom where they served themselves a snack by using a spoon to put small food items (Goldfish crackers, Skittles, or M&Ms candies) from a large bowl into a 2-oz cup. Students then switched roles and repeated the activity before debriefing the experience as a whole-class discussion.

Measures

Studies of disability simulation activities traditionally use self-report measures to assess changes in attitudes after participating in the activity. We administered The Social Responsibility about Blindness Scale (SRBS), which “was designed to measure attitudes toward blindness as a condition and toward the specific expectations of individuals who are blind to perform valued social functions” (Bell & Silverman, 2011, p. 2). The majority of items are negatively worded, for example, "The less vision someone has, the more challenging his or her life will be.” Other items are positively worded, such as, "I would hire a blind person to babysit my children.” The SRBS is a 20-item scale with strong reliability (r = .703, p < .01) and initial evidence of validity (Bell, 2010; Bell 2012).

Because our activity focused on adaptive skills, we also administered a modified version of The Teacher Efficacy in Deafblindness Education Scale (TEDE; Hartmann, 2012) that included only the 22 items related to vision. Efficacy is important in this context because teachers who believe themselves capable of working with students with disabilities may be more likely to engage in inclusive practices. The TEDE is a relatively new instrument with evidence supporting strong internal consistency (Cronbach’s alpha = .98), reliability (Spearman–Brown coefficient = .99), and preliminary assessments of construct validity (Hartmann, 2012).

We measured interest and enjoyment and perceived value and usefulness of the activity using two of seven subscales from The Post-Experimental Intrinsic Motivation Inventory (IMI; Ryan, 1982). The IMI is a widely used self-report instrument with all subscale factor loadings above .6 (McAuley, Duncan, & Tammen, 1987). Fourteen items assessed whether the respondent thought the class period was interesting, valuable, fun, boring (a reverse-coded item), useful, helpful, beneficial, important, held their attention, or improved their understanding of visual impairment. Because the control group did not participate in an activity other than the traditional lecture, we asked all respondents to consider the entire class period when completing this instrument. Finally, students’ achievement was measured using mean class scores on a 10-question quiz taken outside of class time using the university’s online course management system.

Data analysis

Prior to data analysis, reverse-coded items were rescored to compute individuals’ mean scores for each measure such that higher scores indicated more positive attitudes (SRBS), greater self-efficacy (TEDE), and high levels of interest or enjoyment and value and usefulness (IMI). For example, the interest/enjoyment scale was composed of seven questions and responses were averaged to produce a single score for each student. Achievement scores represent class means rather than individual scores because we did not collect personal data on individual students per the IRB protocols so could not determine whether students completing online quizzes were the same as those completing surveys (i.e., students who did not attend class could have taken the quiz and vice versa). Initial response rate was 99.76%. Three students were omitted from the analysis because they answered less than 40% of the questions for at least one scale. We also removed individuals who did not report values for gender (n = 1) or major (n = 2). Thus, we excluded 6 of the original 247 individuals. In addition, examination of boxplots and overlapping kernel density estimation ensured assumptions needed to proceed with modeling were met.

This study followed a cluster randomized design with randomization at the classroom level and the unit of analysis at the student level (students nested in classes). We analyzed the data using Linear Mixed Effects (LME) Models, also known as Hierarchical Linear Models (HLM) or Multilevel Models, using the lme4 package (Bates, Mächler, Bolker, & Walker, 2015) in (R Core Team, 2018). An example of an LME model for the Interest scale is

Interest = intercept + experiment + (class effect) + (random error)

Where experiment denotes the fixed effect of being in either the experimental or control group and terms in parentheses denote random components (i.e., variability due to class membership, which creates dependency or correlation among subjects and individual-level error).

We constructed two models to analyze each outcome. The first model tested for moderators of experimental effects, interactions between condition and gender or major. A moderated or interaction effect occurs if the relation between experimental condition and outcome varies according to, or is conditional on, the level of the third variable (Cohen, Cohen, West, & Aiken, 2003). Gender was coded as male or female; major was coded as preparation for general educators or special educators and related professionals, or other careers. If indicators of interaction effects were not significant (i.e., experimental effects were consistent for men/women and across majors), we then tested for an experimental main effect while controlling for gender and major as covariates.

Using parametric methods for inference in mixed models generally is not recommended (Faraway, 2016). Hence, we did not employ the common format of reporting a test statistic, degrees of freedom, and p-value. Instead, we used nonparametric bootstrap methodology. This technique is based on resampling from the observed data. Another consequence of this type of analysis is that some restrictive assumptions of linear models, such as normality of the random component of the model, are no longer necessary to conduct valid inference. When reporting significance, we provide the change in mean response with p-values estimated via the bootstrap. We also report means, standard deviations, and Cohen’s d, an effect size representing the magnitude of standardized mean difference between the experimental and comparison groups. Generally, effect sizes of .2, .5, and .8 are considered small, medium, and large, respectively (Cohen, 1988).

Results

Analysis showed none of the interactions were statistically significant. That is, experimental effects did not differ for men and women or for students whose majors focused on children with disabilities, children without disabilities, or other types of careers. This result was consistent for all surveys (interest/engagement, β = 0.92, p = 0.86; value/usefulness, β = 0.53, p = 0.71; attitudes, β = 0.2, p = 0.40; self-efficacy, β =−0.02, p = 0.83). Interaction effects are not reported for achievement because the unit of analysis for quiz scores was classes not individuals. Thus, we turn to analysis of main effects.

Students who completed a low vision simulation using instructional technology reported statistically significantly higher levels of interest and enjoyment than those in the lecture-only control condition, β = 1.23; p = 0.02. There were no statistically significant differences between experimental and control groups with regard to attitudes toward visual impairments, β = 0.07, p = 0.37; self-efficacy or confidence in the ability to teach students with visual impairments, β = −0.05, p = 0.67; or perceptions of the value and usefulness of the class session, β = 0.48, p = .16, d = .44. Between-group differences in achievement also were not statistically significant, β = 0.09; p = 0.12.

Means and standard deviations for the experimental and control groups are provided in Table 2, as well as a between-group effect size (Cohen’s d) for each of the outcome measures. As expected following the LME models, the effect size for interest and enjoyment was large (d = 1.07), indicating that the students who experienced the experimental condition enjoyed that day’s class session much more than those who experienced a traditional lecture only. The effect size of .44 indicated students perceived the disability simulation activity to be moderately more valuable or useful than the control condition, whereas differences in self-efficacy and attitude were small (−.12 and .16, respectively). A negative effect size for self-efficacy shows the experimental group scored slightly below the control group on these measures. As shown in Figures 1a–c, differences were minimal.

Table 2.

Means, standard deviations, and effect sizes for experimental and control groups by outcomes.

	Experiment (n = 142)		Control (n = 105)		d
	Mean	SD	Mean	SD	d
Interest and enjoyment	4.75	1.41	6.03	1.01	1.07
Value and usefulness	5.62	1.22	6.12	1.04	0.44
Self-efficacy	3.93	0.47	3.87	0.51	-0.12
Attitude	3.03	0.45	3.11	0.46	0.16

Discussion

Given previous research showing that disability simulation activities may create negative rather than positive attitude changes toward individuals with disabilities, the purpose of this investigation was to assess effects of simulations representing recommended best practices for such simulations on future educators’ knowledge and dispositions related to students with visual impairments. The current study differed procedurally from previous research in two important ways. First, unlike some prior studies demonstrating negative findings (Nario-Redmond et al., 2017; Silverman, Gwinn, & Van Boven, 2015), a disability simulation activity was embedded within a course with a goal of promoting skills and positive interactions with persons with disabilities, and the activity was designed explicitly to be meaningful and enjoyable. Second, unlike studies demonstrating positive (Colwell, 2012) or mixed (Orlansky, 1979) findings in courses related to disability education, we followed a rigorous study design to compare between-group effects on preservice teachers’ perceptions and educational outcomes. We also included a large sample of participants, which is uncommon in this area of research.

Findings revealed positive effects for enjoyment of the activity in the absence of any negative effects. Null findings for changes in attitudes and beliefs indicate that disability simulation activities can be conducted in a manner that is not harmful, which is heartening in light of how often such simulations are reportedly used in classroom settings. However, our findings did not support the widely held (if not well-substantiated) belief that disability simulation activities are effective in improving attitudes toward individuals with disabilities. Also, as has been demonstrated in prior research on active learning simulations (Glazier, 2011), increased enjoyment and engagement did not translate to increases in students’ test scores. One explanation is that the lectures more directly addressed the content of the quizzes than did the activity. For example, students were not assessed on techniques for acting as a human guide, which was a focus of the activity but not addressed in the textbook.

Although increased enjoyment was the only significant finding in this study, we contend that it may be an important one. That is, in a course designed to introduce novice teachers, related service professionals, and parents to the field of special education, creating enjoyable experiences while learning about children with disabilities may be a worthwhile goal in itself. Whether simply enjoying such experiences improves future interactions with children with disabilities remains an empirical question. Nevertheless, if disability simulation activities serve no other purpose than to promote engagement and enjoyment of the class session, we concur with Flowers et al. (2007) that instructors must weigh the costs and benefits of using such simulations in college classrooms. We also encourage instructors to challenge the prevailing belief that disability simulation activities have an immediate effect on attitudes toward people with disabilities.

Limitations

A limitation of disability simulation activity research is reliance on subjective measures of attitudes, interest, value, and self-efficacy rather than direct and objective measures of behavior change. That is, we cannot report whether changes in self-reported beliefs and perceptions are related to changes in participants’ interactions with or behavior toward individuals with disabilities. Another limitation related to measurement was that although the TEDE (Hartmann, 2012) was the only validated instrument of teachers’ self-efficacy to teach children with vision impairments, this scale was validated on in-service as opposed to preservice teachers. It also would have been instructive to measure students’ skill acquisition as a learning outcome, or directly compare knowledge and understanding of human guide protocols in the experimental and control conditions. Additionally, using class mean scores to analyze achievement limited power to detect an effect. Finally, generalizability of findings may be limited because the course included activities and assignments throughout the semester designed to promote positive attitudes toward individuals with disabilities. Although we speculate course activities may have a cumulative positive effect on attitudes toward individuals with disabilities, we were only able to assess immediate effects of the disability simulation activity.

Future directions

As Kiger (1992, p. 76) stated, “We should be modest in our expectations of a disability simulation’s effectiveness to change attitudes dramatically. Perhaps participation in a simulation will have a cumulative, synergistic effect with other educational experiences.” Just what other types of experiences should be provided remains to be determined empirically. For example, we allowed students to self-select the type and degree of visual impairment they experienced. Future studies could analyze variations in responses among students who self-select or are assigned to conditions with relatively more (e.g., total blindness) or less (e.g., macular degeneration) occlusion. Additional recommendations have included increasing contact between disabled and nondisabled individuals when both planning and delivering disability simulation activities (Burgstahler & Doe, 2004; Nario-Redmond et al., 2017). Several authors also recommended using such simulations as a tool to promote social justice, for example, by focusing on issues like stigma, accessibility, policy, fairness, discrimination, inclusion, stereotypes, oppression, and equity (Barney, 2012; Lalvani& Broderick, 2013; Leo & Goodwin, 2013).

Instructors are encouraged to consider that disability simulation activities are considered entirely inappropriate by some disability advocates. We wholeheartedly agree that such simulations should never be used as a "one-shot," decontextualized activity, for example, one that is done for extra credit or as part of disability awareness week activities (Lalvani & Broderick, 2013; Nario-Redmond et al., 2017). Disability simulation activities may also be inappropriate even when adhering to best practices recommended by members of the disability community. For example, the activity we designed might be unsuitable for a novice instructor with little experience in managing large groups or debriefing potentially uncomfortable topics. Similarly, it should not be used as an introductory activity or in a class in which trust and rapport has not been established.

Conclusions

This research contributes to our understanding use of disability simulation activities in preparing professionals to work with children with disabilities in school settings. Based on data showing that such simulations resulted in positive engagement in the absence of harmful effects, we conclude that it is not productive to either promote or denigrate disability simulation activities wholesale. Rather, we should be thoughtful in discussions and purposeful in deciding whether to implement such activities in a given setting, for a given purpose. Instructors who do continue this practice must consider the social model of disability and design activities to promote equity, accessibility, and inclusion of individuals with visual impairment or blindness as well as teach adaptive skills for participants. Incorporating these recommendations will ensure that we do no harm in our efforts to ensure enjoyable learning experiences, enhance emerging educational professionals’ knowledge and understanding of students with diverse needs, and increase their preparedness to function in complex and diverse settings.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article. This work was supported by a Technology Integration Grant from West Virginia University’s Teaching and Learning Commons.

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