my life: our lessons
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My life: Our Lessons. Timothy Cordes, PhD, MD. Disclaimer. This presentation is my own. It does not reflect the views or opinions of the government of the United States or its Veterans Administration. I have also received funds from Vanda Pharmaceuticals for unrelated work. Outline. - PowerPoint PPT PresentationTRANSCRIPT
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My life: Our LessonsTimothy Cordes, PhD, MD
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This presentation is my own. It does not reflect the views or opinions of
the government of the United States or its Veterans Administration.
I have also received funds from Vanda Pharmaceuticals for unrelated work.
Disclaimer
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Conceptualizing disability Challenges and strategies
◦ Technical challenges◦ Conceptual challenges
Examples of successful accommodation Parting ideas
Outline
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“To make strength productive is the unique purpose of organization”
“It cannot, of course, overcome the weaknesses with which each of us is abundantly endowed. But it can make them irrelevant.”
Considering Strengths
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“Strong people always have strong weaknesses too. Where there are peaks, there are valleys. And no one is strong in many areas. Measured against the universe of human knowledge, experience, and abilities, even the greatest genius would have to be rated a total failure. There is no such thing as a ‘good man’. ‘Good for what?’ is the question.”
From Peter Drucker
Considering Strengths
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How do we think about disability
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The Computational Model of Accessibility
if (student - disability + accommodations) > task then accessibility = true else accessibility = false
Student - Disability +
Accommodation Task
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Benefits of the Computational Model
Simple
Defines a clear relationship
Intuitively fits our way of viewing disability
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Assumes quantities are static◦ Can students abilities improve?◦ Is the task truly fixed?
Assumes the disability is negative Assumes all measurements are accurate Provides no direct role for the educator
Limitations
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As simple as possibleAcknowledges active role of educator and student
Incorporates strengths of each Implies ultimate goal is accommodation
Emphasizes the dynamic nature of the process
Ideal Model
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Journey Model
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From Ex-anatomy.org
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Challenges are a reality for the disabled in higher education2 main categories of challengesTechnicalAddressed through the appropriate use of tools and technologyConceptualCreated by inaccuracies in how people think about disability and accommodationCan be more difficult to recognize and addressSuccess depends on the combination of technical and conceptual challenges
Challenges on the Journey
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Technology◦Simple ◦Complex
TechniquesAttitudes◦Acceptance
Tools for Addressing Challenges
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◦Define the problemAssess strengths and skills
◦Have open discussions◦Investigate options◦Be creative
Finding Tools
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Core skills of disability◦ Lip reading, Braille, etc.
Technical skills◦ Computers◦ Performance arts◦ Athleticism◦ Hobbies
Personal attributes◦ Motivation◦ Persistence◦ Willingness◦ Adaptability
Think Broadly about Tools
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Tools Are Ubiquitous
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An Optacon
Sometimes the newest tools aren’t the best.
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Skeletons, heart and brain models Clay models describing blood cell shape and
appearance Organic chemistry models Simple plastic raised-line drawing kits Veterinary syringes to measure liquids ILAB project now makes a variety of
accessible lab equipment
Examples
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Counter-transference◦ A psychological concept which encompasses
how a therapist feels towards a patient
◦ Needs to be brought into conscious awareness
◦ We all ‘see’ things through our own lens.
◦ In order to build bridges , we need to be aware of what we and those around us carry with us.
Conceptual Challenges
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The “If I can’t do it without that sense or ability, then …”
Perpetuated by well meaning advocates
Neglects◦Skills that the individual has acquired to
compensate◦Actual neuroplasticity
Common Conceptual Challenge
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The brain's ability to reorganize itself by forming new neural connections throughout life.
Neuroplasticity allows the neurons in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.
Neuroplasticity
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The occipital cortex, which processes visual information in sighted individuals is active when a blind person reads braille. From J Neurophysiol. Jan 2002; 87(1): 589–607
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Changes in patterns of brain activation occurred after 5 days of blind folding
Occipital cortex became active in sensory and auditory tasks
Visual cortex has been found to be active in braille reading and verbal memory tasks
Auditory cortex has been activated in the deaf while lip reading
Examples of Neuroplasticity
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How I learned to handle this barrier
Embracing the power of dreams
One cannot “achieve” without “conceiving” first
If we stop at the conceptual phase, we block achievement.
An Antidote
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Happens when we confuse the model with reality
Example: anatomy course◦ Standard procedure was to identify nerves,
muscles, and blood vessels visually◦ True task is to know the structures◦ Identifying by feel is equivalent
Protein structure◦ No one has ever “seen” the 3-D structure of a
protein◦ All models are approximations
The Model Trap
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“That’s just not how we do things.”
Prevalent in medicine and surgery
Solution: Simultaneous rejection of the premise while embracing a greater goal or idea
Variant: The Tradition Trap
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What is your purpose◦How does it give meaning to surmounting the barrier
Why are you here?
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How could a blind person understand the 3-dimensional structure of a protein◦Need a way to appreciate distances◦Need a way to understand spatial
relationships◦Need a way to use a tool in near real-
time on multiple structures.
A Challenge
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Technology◦ Computing resources◦ Publically available routines for computer graphics◦ Interest of my supervisor
Techniques/Skills◦ Auditory spatial abilities◦ Musical experience◦ Programming experience
Available Tools
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Explores the protein by moving a selection sphere or 3D cursor
Text output describes the contents of the selection sphere
Gives atom name identifiers and x, y, z location for each
TIMMol
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TIMMol plays tones to indicate atom position and identity
X axis: Left and right ear Y axis: Pitch Z axis: Softer and Louder
TIMMol Audio Output
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Sample Graphical Output
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We asked 9 adults with some structural biology experience to participate in a trial of TIMMol.
With brief training, a majority of participants could identify a beta-sheet, a common structural element of proteins.
Participants were also able to correctly identify spatial relationships (like +y or –z) between atoms 88% of the time.
People with less experience with traditional molecular visualization packages were more successful with TIMMol.
Lessons from TIMMol
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Once you decide something can be done, it just becomes a matter of how.
Anatomy by touchRaised-line drawings Work with describersScreen readers to access the medical record
Medical School
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Adapted elements of the physical exam to do by touch (avoiding the Model Trap)
Using an optacon to read EKG’s (old technology)
Identifying organs by touch in surgery Use of clinical simulators Placing breathing tubes
Clinical Training
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See dozens of patients a week independently
Settings range from a clinic, to a psychiatric ward, to the emergency room
I specialize in helping with those with addictions
I use computers to complete paperwork and documentation
I also teach medical students and resident physicians
My Bridge, Tomorrow who knows …
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Building bridges is a dynamic process
Utilizing tools, techniques, and attitudes
Undertaken with an awareness of our own strengths and weaknesses
Capitalizing on the student’s strengths
Summary
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Today’s technical tools are amazing and barriers are falling rapidly.
The remaining barriers are nothing compared to the power of our hearts and minds when fully engaged.
With openness, persistence, creativity, and cooperation, we can build bridges to tomorrow.
Closing Thoughts
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Journey Model