Elena Martinelli, President of the Fondazione Alfredo Catarsini 1899 – Associate Professor of Motor Sciences, University of Florence.
Interview by Monica Bernacchia
Even children Introduction and aim of the project
“Let’s change out look!” is a challenge, a project for social inclusion by means of an experiential and multisensory exercise workshop. The aim is to make images and works of art more accessible to the visually impaired and those with acquired blindness so as to improve their health and their quality of life. By studying the influence of motor activity on sensory perception it is hoped to enable people with acquired visual impairments to enhance their abilities and to learn new skills. Since the project is promoted by the Fondazione Alfredo Catarsini 1899, which mainly deals with art, the intention is to use the figurative arts as a means of assessing the effective results achieved through physical exercises specifically devised to enhance sensory and cognitive perception (Sensory reactivation on a motor basis using C.A.MO method).
- In your experience, how do lifestyles change in blind or visually impaired people?
Even though you are able to use some visual information, you can still have problems recognizing colours, reading, focusing on an image. You are often forced to change job and adapt the home environment to meet your new needs. It is a real effort, and every failure feels like you are slipping backwards and tempts you to give up. The main consequences involve the emotional, psychological and motor spheres. Even if the visually impaired person is open to new ventures, the family entourage can react in an overprotective manner which encourages sedentariness, isolation, fewer stimuli, with everything that follows on from that.
The visual deficit conditions the way in which people glean information from the environment and relate to it, and it determines an alteration in the perceptual processes and a different way of acquiring information. But these people can nonetheless achieve a satisfactory quality of life by adopting specific strategies for using their residual visual capacities and compensating for the information shortfall. There are methodologies not just for stimulating the other senses but also for devising new and hitherto unexplored treatments, such as the use of adapted motricity, which is our sphere.
- What damage can be caused to the central nervous system by the cancellation or severe reduction of sight?
Normally sight loss is at least partially compensated by smell, hearing and touch. This is made possible by the innate ability of the brain to adapt in response to experiences (neuroplasticity). But what changes in the brain of a blind person? Research on people blind from birth – led by neuroscientists at the Eye and Ear Infirmary in Boston and published in PLOS One – has shown evidence of functional and structural changes in the brains of people with congenital blindness: the changes are much more extensive than was previously thought and affect not just the area of the occipital cortex, normally concerned with image processing, but also areas assigned to the higher cognitive functions, like memory and language, which are reduced in volume and thickness respectively.
Another study into the consequances of glaucoma, conducted by the University of Siena in 2016, showed that the neurodegenerative process might not be limited to the visual system but could also affect other brain systems.
So we know that in the absence of visual stimuli the brain alters, but we are still studying what new connections are formed, and therefore how we can intervene to enhance the person’s ability to interact with the environment. However, it is known that the enhancement of blind people’s abilities depends on activity, on practical exercise. The challenge we have set ourselves is precisely this: to assess the extent to which, in a person with acquired blindness, you can limit brain damage and how far they can be assisted in acquiring new abilities (like using computer systems, sensory maps etc.) through the C.A.MO method of sensory reactivation on a motor basis.
- How does the visual memory change in a blind or visually impaired person?
We mentioned before that the areas of the brain assigned to image processing and visual memory are reduced in volume and thickness respectively. But we know that mental abilities can be improved through practice and also that there is a very efficient compensation mechanism (vicariance) which comes into play when a sensory abiliy is lacking. The visually impaired tend to use sensory memorization strategies in everyday circumstances, so they train this mental ability to the utmost and display a greater overall memory.
Moreover, blind people are able to dream images, even when they have had no visual experience of them. We bear this in mind in our exercises designed to activate the perceptual processes by stimulating the higher cognitive functions (like abstraction, memory, language, imagination). These exercises process the stimulus and interpret it. In fact, a person who cannot see nonetheless has sufficient competencies, albeit reduced, to form a mental image of something they have never actually seen. Furthermore, linguistic input has a key role in supplementing and completing the information that blind people gather through the sense organs – hence our quest to codify the way to illustrate an image (whether a work of art or an advertising poster) so that they can understand better, learn and benefit by acquiring the same descriptive scheme.
- So what do you think can be done to enhance sensory and cognitive perception?
The eye is an exteroceptive organ but it is also the main source of kinaesthetic perception directed to the postural tonic system which transmits it to the central nervous system; it enables us to understand distances, perspective and acquire eye-hand and space-time coordination. Visual problems, whether dependent on sense or brain organs, whether total or partial, have consequences for the perceptual and motor system and cause posture modification precisely because of the series of connections between the visual system and the structures and constituents of the static and dynamic posture regulation system. Vision and posture are two mechanisms within a single perceptual process, so our teaching approach is based on the postural rebalancing that can be achieved through practical exercises.
As regards the postural disorders consequent on impaired vision, the most common are: a bent back, head jutting forward and shoulders advanced, resulting in poor load distribution for the spinal column, the pelvis and the lower limbs; opening of the support base of the feet, shorter steps, stiffness in the heel, altered deambulation, balance loss and tiredness, resulting in stiffening of the joints and loss of overall strength. All these changes, together with sedentariness, form a vicious circle which causes a reduction in motor capacity, chronic difficulty in moving, balance and orientation problems, and feelings of fear and inadequacy. My advice is “to stay ahead of the game”: the period of deterioration is a precious time, you must not delay but use the time immediately by involving the visually impaired person in sensory reactivation courses using the C.A.MO motor-based method.
By using proprioceptive strategies, the contribution of Motor Sciences is decisive in stimulating a knowledge of one’s own body and static and dynamic posture through exercises which involve the whole body, beginning with plantar support, the arrangement of the lower limb and pelvis and the behaviour of the spinal column, all factors which affect balance and weight distribution when standing erect or walking. Motor-based proprioceptive-cognitive strategies are effective and easily practised by all ages – children, adolescents, adults and the elderly – and through personalized work it is possible to modulate the sensitive afferents and the responses to the extent of modifying the postural state as regards the central nervous system. Postural awareness is a “motor skill” which produces important results: there is an increase in the strength, resistance, suppleness and sense of wellbeing which movement generates in all of us, and, as a result we gain greater confidence in ourselves and our abilities. This procedure furnishes the essential premises for helping the visually impaired to acquire new skills, too, such as, in our case, using equipment and devices for reinterpreting the image and the work of art…and much else!