3D Printing as a Teaching Tool for People who are Blind and Visually Impaired

3D Printing as a Teaching Tool for People who are Blind and Visually Impaired

Julia VanderMolen, Ph.D., CHES Jennifer Fortuna, Ph.D., OTR/L

Grand Valley State University

Abstract

Three-dimensional (3D) printed materials have been found to promote spatial awareness in people who are blind and visually impaired. Research has shown 3D printed materials can make abstract concepts, such as severe weather, easier to understand. Much of the existing research related to weather and disability is focused on people with physical disabilities. Severe weather poses a safety threat. Therefore, it is important to address spatial awareness and understanding of severe weather patterns in this population. Developing 3D printed models of severe weather patterns (i.e., clouds and hail) is one way to accomplish this. Occupational therapy practitioners have the skills to develop 3D printed models for use as a teaching tool and assistive technology intervention. This study explores how 3D printed models influence spatial awareness and understanding of severe weather patterns (i.e., clouds and hail) in people who are blind and visually impaired. This study employed a nonexperimental descriptive design using an electronic survey to collect data from a nonprobability sample. Descriptive statistics were used to analyze the data. The information gained from this study can be used to inform future research and guide clinical practice.

Keywords: occupational therapy, visual impairment, 3D printing, assistive technology, educational technology

3D Printing as a Teaching Tool for People who are Blind and Visually Impaired

Globally, it is estimated that at least 2.2 billion people live with visual impairment or blindness (World Health Organization, 2019). The International Statistical Classification of Diseases 11th Revision (ICD-11) defines visual impairment as deficits in the ability of the person to perform vision-related activities of daily living (ICD-11, 2019). Since vision is the primary sensory system used to gather information from the environment. People who are blind or visually impaired often rely on input from multiple sensory systems to orient themselves in the world. Touch is one of the most important senses used to compensate for the absence of vision in spatial tasks. Tactile training can enhance acquisition of spatial knowledge (Leo et al., 2017). Interactions with tangible materials such as braille labels, interactive maps, and threedimensional (3D) materials reinforce learning in people who are blind and visually impaired (Sandberg, 2016). Incorporating auditory input into educational activities provides an additional strategy for developing a conceptual understanding of the world. According to Hull (1990), the sound of rain can promote an understanding of differences in place, speed, and intensity.

While seasonal weather changes may invigorate the senses in a person with sight, severe weather has the potential to disorient, threaten, and isolate people with visual impairment (Bell et al., 2018). These experiences can exacerbate feelings of marginalization. In addition, visual

impairment can make it difficult to avoid obstacles, problem-solve, and assess the environment for danger (Bell et al., 2018; Hull, 1990). Therefore, it is important to identify teaching tools that can be used to promote spatial awareness and understanding of abstract concepts, such as those common in geography, science, and mathematics (Giraud et al., 2017). Attending to the weather is essential if we are to fully understand people’s experiences of well-being, impairment, and disability (Bell et al., 2018).

Much of the existing research on weather and disability is focused on challenges faced by people with physical disabilities. Few studies have explored how people who are blind and visually impaired experience the weather. 3D printed materials have been used to promote spatial awareness and understanding of abstract concepts in people who are blind and visually impaired. Research suggests the sense of touch compensates for the absence of sight by allowing for the coding of spatial patterns to emanate from tactile stimuli instead of visual input (Cohen et al., 2011; Ruggiero & Iachini (2010). Research has explored the translation of images of astronomical and biological objects into 3D models so students with visual impairment may explore the concepts through touch (Grice et al., 2015; Reynaga-Peña, 2015). A literature review by Ford and Minshall (2019) found 3D printing is often used to support science, technology, engineering and mathematics (STEM) curriculums in K-12 settings. In addition, 3D printed materials have been found to improve spatial awareness and understanding of spatial relationships between objects in special education settings (McLoughlin et al., 2016). For example, use of 3D printed tactile artifacts such as picture books and maps have been created to clarify abstract concepts for children who are blind or visually impaired (Jo et al., 2016).

Occupational therapy practitioners have the training and education to develop educational interventions that will enhance spatial awareness and promote safety in people who are blind and visually impaired. Occupational therapists also have a unique understanding of the sensory systems which is necessary for promoting spatial awareness. The Occupational Therapy Practice Framework (4th Edition), categorizes safety, and emergency maintenance as an instrumental activity of daily living (IADL) (American Occupational Therapy Association [AOTA], 2020). Matters of safety often include activities considered to be more complex than everyday activities of daily living. Safety and emergency maintenance is defined as “Evaluating situations in advance for potential safety risks; recognizing sudden, unexpected hazardous situations and initiating emergency action; reducing potential threats to health and safety, including ensuring safety when entering and exiting the home” (AOTA, 2020, p. 31). In occupational therapy intervention, use of assistive technology may include education and training in the use of lowtech devices such as 3D printed materials. Creating 3D printed models to enhance understanding of severe weather patterns (i.e., clouds and hail) is one example.

Few studies have examined how people who are blind and visually impaired perceive severe weather. In addition, the field of occupational therapy lacks research providing guidance on the use of 3D printed materials in practice. The purpose of this study is to explore how 3D printed models of severe weather patterns may influence spatial awareness and understanding of severe weather patterns in people who are blind and visually impaired. This study aims to answer the following research question: How do 3D printed models influence understanding of severe weather patterns in people who are blind and visually impaired? The information gained from this study can be used to inform future research and guide occupational therapy practice.

Method

This study was approved by the Institutional Review Board at Grand Valley State University. This study employed a nonexperimental descriptive design using an electronic survey to collect data from a nonprobability sample. Participants attended a severe weather training program. Data was collected using a cross-sectional electronic survey. Descriptive statistics were used to analyze data.

Participants and Sampling

Researchers recruited a sample of adults who are blind and visually impaired. Participants were recruited in collaboration with a local community organization providing services to people who are blind or visually impaired. To qualify for this study, participants had to meet the following inclusion criteria: (a) over the age of 18; (b) either blind or visually impaired; (c) English speaking; and, (d) must have attended the SkyWarn Severe Weather Training. Of the 40 potential participants recruited, 35 people met the full inclusion criteria.

Procedures

SkyWarn Severe Weather Training Program

Participants attended a SkyWarn Severe Weather Training Program led by a meteorologist from the National Weather Service. The four hour training took place at a local church located in Grand Rapids, Michigan. The SkyWarn Program is a nationwide network of over 350,000 trained volunteers who report severe weather to the National Weather Service (National Weather Service, n.d.). Storm spotters attend training to learn how to identify potential severe weather features such as clouds, wind, and hail. For this study, the researchers organized a SkyWarn training specifically for people who are blind and visually impaired. This training was different from traditional SkyWarn programs because the researchers incorporated several 3D printed models of cloud formations and hail into the course materials.

3D Printed Models

3D printed models representing severe weather patterns (i.e., different types of clouds formations and hail sizes) were provided to abstract concepts (i.e., severe weather patterns) easier to understand. The researchers collaborated with coordinators from the SkyWarn Storm Spotter Program to determine which cloud formations and hail models were required to fit the training needs of study participants. The following cloud types and hail sizes were developed for this study using a 3D printer: funnel clouds, wall clouds, dime size hail, quarter size hail, and golf ball size hail. The measurements of each model are referenced in Table 1. In addition to these models, the researchers incorporated another 3D model, referred to as “Mr. Fuzzy,” to assist with illustrating the conceptual components of a thunderstorm. The Mr. Fuzzy model was shaped like a wall cloud and made from cotton.

Table 1. Measurements of 3D Models for Severe Weather Training Type of Model Height (in mm) Length (in mm) Width (in mm)

Funnel Cloud Wall Cloud 80 65

Hail (Golf Ball) 42.70 Hail (Quarter) 24.26 Hail (Dime) 17.91 100.76 115

42.70 24.26

17.91 101.02 90

42.70 24.26

17.91

Once the model dimensions were determined, the Ultimaker 2+ Extended Model 3D printer was used to create the models. The Ultimaker 2+ printer was readily available at the researchers’ institution. This printer was selected for its print quality, ease of use, and reliability. The cost was also a factor. The price range for this printer was approximately $2,500. Educators and researchers can explore similar 3D printers using 3D Hubs, an online index that compares printers by price and customer review (3D Hubs, 2019). Another benefit of the Ultimaker 2+ printer is that the company makes Polylactic Acid (PLA) filament that is affordable and easy to print. PLA is a dense plastic material known for its durability and highly detailed 3D printing capabilities (Wagner & Autodesk Inc., 2017). For this project, the cloud formations and hail models were designed to feature specific details. Thus, PLA was identified as the optimal choice.

The cloud formation files were created using Tinkercad, a computer-aided design (CAD) software with the ability to create designs, as well as search for existing 3D models in a vast repository. Manipulating various common and identifiable shapes allowed the cloud formation and hail model designs to be created by referencing a photo of the correct cloud type. The 3D formulating process varies depending on the skill level of the developer. Tinkercad has a simple interface that can be used to create designs based on a scientific concept. On average, the design process for each cloud model took approximately 30-minutes (see Figures 1 and 2). The figure files are available on Thingiverse, a website repository dedicated to sharing 3D digital design files (Makerbot Industries, 2019).

Figure 1. Digital representation of the wall cloud model created using Tinkercad.

Figure 2. Digital representation of the funnel cloud model created using Tinkercad.

In total, it took the researchers two to three hours to accurately define six different cloud formation models. The process to render each file took an additional 30 minutes. The time required to print one cloud model on a commercial-sized 3D printer was 30-minutes to one hour depending on the size of the extrusion nozzle. Examples of 3D printed cloud types and hail sizes are provided in Figures 3-5.

Figure 3. Photograph of a 3D printed wall cloud.

Figure 4. Photograph of a 3D printed funnel cloud.

Figure 5. Photograph of various 3D printed hail sizes with braille labels.

Survey Instrument

After the training, participants were invited to provide anonymous feedback on the SkyWarn training. An electronic survey was selected due to convenience, cost, and rapid turnaround in data collection. The researchers created an 11-item electronic survey instrument using Qualtrics software (Qualtrics, 2019). This software was selected because it is accessible to participants who rely on optical devices such as screen readers. The survey gathered feedback from participants on the benefits of using 3D models to learn about severe weather. The purpose of the first question was to provide instructions and obtain informed consent. Of the remaining questions, five requested open-ended feedback on the 3D models and sound clips; and, five questions were related to content delivery and could be answered with a ‘yes’ or ‘no’ response. To reduce threats to content validity, experts from the field of blindness and low vision. Additionally, the survey was pilot tested and later refined based on feedback provided by two individuals who are blind. Pilot testing did not result in changes to the survey questions; however, formatting changes were necessary to ensure all participants using a screen reader could gain access.

Variables

This study incorporated 3D models into the SkyWarn training to promote understanding of spatial concepts including cloud formations and hail sizes. Audio clips were also embedded into the training to reinforce learning. By including the audio clips, participants were able to both hear and feel the differences between hail sizes. Although audio clips are not a variable of interest in this study; the researchers acknowledge the potential influence this may have on participant understanding of severe weather patterns. For this reason, audio clips are a confounding variable in this study. Table 2 relates key variables to survey items.

Table 2. Variables and Related Survey Items

Variable

Independent

Name

3D Models

Survey Item

Questions 2, 3, 7, 8, 9 Dependent Understanding Questions 2, 3, 5, 7, 8, 9, 10 Confounding Audio Clips Questions 2, 3, 10

Data Analysis

Data analysis was completed using IBM SPSS Statistics, Version 25 (IBM Corporation, Armonk, NY). A descriptive numerical summary and qualitative thematic analysis were used to summarize the results. The researchers analyzed open-ended survey responses with a basic coding process to identify themes. Thematic analysis was used to identify themes around core concepts.

Results

In total, 20 participants completed the full survey, resulting in a 57.14% overall response rate. All 20 participants (100%) reported the 3D models promoted understanding of cloud formations and hail sizes. Furthermore, all 20 participants (100%) reported the sound clips were helpful. Several participants stated the sound clips for wind and hail were especially helpful. Study participants suggested the researchers create additional 3D models that can be incorporated into

future training. The majority of participants (90%) found Mr. Fuzzy helpful for understanding what a severe thunderstorm looks like. A summary of survey questions, responses, and common themes are summarized in the order they were presented in Table 3.

Table 3. Survey Questions and Responses

Question 1. Informed consent and instructions. Response

2. In general, what did you like, or find useful from the session?

3. Was there anything you did not like about the session?

Question

4. Did the presenter from the

National Weather Service keep your interest throughout the session? 5. Were the presentation slide descriptions helpful, and in an accessible format?

6. Did you have adequate assistance before, during and after the training session?

7. Do you think the 3D models helped you learn and understand hail sizes and cloud formations? “Having audio clips to go along with 3D models.”

“The 3D models were especially useful.” “The sound clips and 3D representations. It was good to hear what different hail sizes sound like as they fall.” “I enjoyed learning how the blind can also help with tracking weather.” “As someone interested in the weather, I enjoyed hearing about different types of severe weather and using the models of clouds from a thunderstorm.”

“No” (n = 18) (90%)

“The sound examples of hail stones went on too long; 15 seconds should be enough for people to get the idea.” “As a weather enthusiast, I would argue the session was too short.”

Response (n = 20), n (%) “Yes” (n = 19) (95%)

“No” (n = 1) (5%)

“Yes” (n = 20) (100%) “No”(n = 0)

“Yes” (n = 20) (100%) “No”(n = 0)

“Yes” (n = 20) (100%) “No”(n = 0)

8. Were some images more helpful than others? If so, please explain.

9. Was Mr. Fuzzy useful in terms of helping you understand what a severe thunderstorm looks like?

10. Did you find the sound clips to be helpful? Please explain.

11.

What suggestions do you have for future sessions?

“Yes, the 3D prints were better.”

“Yes, I would have liked the 3D models larger.” “Having the models labelled in braille helped with all of the images.” “The wall and funnel cloud images were especially helpful.” “I liked the models and would love to see more.”

“Yes” (n = 18) (90%) “No” (n = 2) (10%)

“Yes” (n = 20) (100%) “Great calibration for wind speed.”

“It helps to understand the difference in the sound at different wind speeds and hail sizes.” “They were helpful. It’s good to be able to hear the contrasting sounds of various wind speeds and hail sizes.” “I didn’t realize that with a tornado there are a variety of sounds you can hear. The different wind speed sounds were very helpful in distinguishing approximate wind speeds.”

“Keep adding audio clips. Maybe one of rushing flood water. Talk about the difference in sound and how it affects mobility when snow is on the ground.”

“More 3D cloud formations. The funnel cloud was great and the hail stones too.” “3D images of additional cloud types and thunderstorm components would be helpful.”

Discussion

This study explored how 3D printed models influence understanding of severe weather patterns in people who are blind and visually impaired. Additionally, the researchers aimed to provide guidance on the use of 3D printing in occupational therapy practice. The results of this study found incorporating 3D models into the SkyWarn Training had a positive influence on understanding of severe weather patterns. All participants reported the 3D models enhanced their understanding. Several participants requested that the researchers create additional 3D cloud formations that can be added to future trainings. A study by Jo et al., (2016) also found that 3D

printed materials increased comprehension for blind and visually impaired students who found oral explanations difficult to grasp. One major advantage of 3D printing technology is the ability to create individualized materials for participants and students with varying degrees of visual impairment. 3D printing software allows the creator to design customized models and to scale down large objects to highlight core features and increase comprehension through touch (Jo et al., 2016).

This study identified several advantages to incorporating 3D printing into occupational therapy practice and educational settings. For example, 3D printing provides an accessible, affordable, and adaptable means of assistive technology. There is a wide range of applications and opportunities for creativity and problem solving (Schwartz, 2018; Ganesan, Al-Jumaily & Luximon, 2016). Integrating Braille as a modality for treatment is one example. 3D printers are available at affordable prices ranging between $500 for basic printers, up to $5,000 for the more advanced models. Finally, occupational therapists who incorporate assistive technology are often limited to costly, pre-fabricated devices that may not meet their client’s individual needs (Schwartz, 2018). 3D printing also makes it easy to individualize treatment in a cost-effective manner.

Limitations

No study is without limitations. The results of this study were limited to a small sample of participants with visual impairment. The individual vision-related diagnoses and severity level (e.g., visual acuity) of visual impairment was not reported in this study. In addition, audio clips served as a confounding variable that was not controlled. These limitations may impact the generalizability of results to the greater population of people who are blind or visually impaired. During the process of creating the 3D cloud formations and hail sizes, the following limitations were recognized. There was a learning curve when learning to use the Tinkercad software. Also, the researchers discovered they needed additional cloud models to accommodate a large number of participants at the training. The inclusion of additional cloud types and more components would allow for more efficient use of time for the study participants. The restriction of the size with the 3D printing hardware itself was also a limitation. The cloud and hail model sizes were limited to 7.5 inches in both width and length. Finally, having larger 3D models to accompany the audio explanations may have reinforced learning.

Lessons Learned

The researchers faced a few challenges as the project unfolded. First, using 3D modeling software programs involves a learning curve. However, the researchers found having basic familiarity with CAD helped to mitigate the issue. Additionally, accessibility varies greatly and is determined by the needs of the individual with visual impairment. For example, with Braille, the legibility varies when using uppercase versus lowercase letters. Thankfully, Thingiverse (Makerbot Industries, 2019) offers a braille collection with a multitude of predesigned files. Because both designers and users must understand and know how to implement changes to such variables, stakeholders must track many elements throughout the project.

Designing the cloud formations and hail replicas helped the researchers acquire a better understanding of the 3D printing process. Before starting the process, there was a limited

understanding of CAD software and Tinkercad. Throughout the design process, comprehension of the simplistic interface began to improve. This provided an opportunity for the researchers to use the software to its fullest capabilities. By creating the 3D designs to be as fluid as possible, the software allowed for a deeper understanding of creating interlocking parts and how to best represent 2D images on a 3D platform. By creating the 3D formations, the program provided a newfound respect for the printing process and how to best suit a 3D design file to print with expected quality.

Conclusion

This study examined how 3D printing can influence understanding of severe weather patterns in people who are blind and visually impaired. In addition, this study aimed to identify how occupational therapists may benefit from using 3D printing in clinical practice. The information gained from this project may be valuable to health care professionals, educators, and individuals who are blind and visually impaired. Teachers and other health care professionals may use this information to develop 3D printed materials to reinforce learning of abstract or science-related concepts. This information can also be used to assist occupational therapists interested in using 3D printed models to increase understanding of spatial concepts in people with visual impairment. Health care professionals can also use this information to develop individualized assistive technology interventions. 3D printed models as assistive technology may reinforce learning, safety, and engagement in occupations for people with visual impairment.

Implications for the Field

Occupational therapy practitioners prescribe assistive technology; however, they are often limited to costly, pre-fabricated devices that may not meet their client’s individual needs (Schwartz, 2018). This study demonstrates how occupational therapy practitioners can use 3D printing to design and manufacture their own assistive technology and educational tools that can be incorporated into intervention. Moreover, 3D printing can increase access to assistive devices for clinics serving the underserved, including those in low-income and rural facilities. Future research with a larger and more representative sample, blinding, and a control group is suggested. Furthermore, more experimentation and collaboration are needed to establish the best practice of 3D printed assistive technology and to meet the individual needs of people with visual impairment.

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About the Authors

Julia VanderMolen, Ph.D., CHES, is an Associate Professor of Public Health with Grand Valley State University in Michigan. The contribution of her research is to examine the benefits of assistive technology, UD and UDL. Additionally, Dr. VanderMolen’s recent work has included the benefits of 3D printing for the visually impaired, the concept of universal design and learning and the use of mobile technology to assist individuals with disabilities. Jennifer Fortuna, Ph.D., OTR/L, is an occupational therapist and Assistant Professor at Grand Valley State University in Grand Rapids, Michigan. Dr. Fortuna teaches graduate courses in the Department of Occupational Science and Therapy. Her research interests include health literacy, visual impairment, accessibility, and universal design.