My life: Our LessonsTimothy Cordes, PhD, MD

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

Conceptualizing disability Challenges and strategies

◦ Technical challenges◦ Conceptual challenges

Examples of successful accommodation Parting ideas

Outline

“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

“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

How do we think about disability

The Computational Model of Accessibility

if (student - disability + accommodations) > task then accessibility = true else accessibility = false

Student - Disability +

Accommodation Task

Benefits of the Computational Model

Simple

Defines a clear relationship

Intuitively fits our way of viewing disability

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

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

Journey Model

From Ex-anatomy.org

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

Technology◦Simple ◦Complex

TechniquesAttitudes◦Acceptance

Tools for Addressing Challenges

◦Define the problemAssess strengths and skills

◦Have open discussions◦Investigate options◦Be creative

Finding Tools

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

Tools Are Ubiquitous

An Optacon

Sometimes the newest tools aren’t the best.

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

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

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

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

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

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

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

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

“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

What is your purpose◦How does it give meaning to surmounting the barrier

Why are you here?

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

Technology◦ Computing resources◦ Publically available routines for computer graphics◦ Interest of my supervisor

Techniques/Skills◦ Auditory spatial abilities◦ Musical experience◦ Programming experience

Available Tools

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

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

Sample Graphical Output

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

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

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

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 …

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

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

Journey Model