Approaches to Tactile Instruction

Authors: Sara Kitchen, VI Outreach Consultant, Texas School for the Blind and Visually Impaired, TSBVI, and Adam Graves, VI Program Coordinator, San Francisco State University

Over time and through experience, vision professionals build skills and gather information to help better interact with students through the tactile sense. Usually, this happens because their students teach them the kind of touch that inspires them, aggravates them, or causes them to shut down. But what is really known about the tactile sense? Many practitioners outside the field of visual impairment use something called “Hand-Over-Hand” to manipulate a student’s hands and move them through an activity. However, advanced practitioners and experts in the field of visual impairments have provided anecdotal evidence and case studies that support the use of “Hand-Under-Hand” and self-directed touch based on their many years of experience. 

While much has been written by practitioners on the benefits of Hand-Under-Hand touch, we questioned whether these assertions were actually supported by studies in scientific research. 

As vision professionals, it makes sense to strive to understand how information from the tactile sense is processed by the brain and be sensitive to the kinds of messages we communicate to students through OUR touch. General teaching pedagogy integrates information about how children learn through distance senses and how the brain best processes visual and auditory information. However, there is not yet specific training for teachers on how the brain processes touch. 

In 2020, we began research to help us understand more about the biological and social responses to touch in humans. We conducted a literature review to find answers to our questions. You can read that review in the Journal of Blindness and Visual Impairment in an article called Review of Literature Addressing Biological and Social Responses to Touch: Instructional Implications, first published online on Sept 5, 2024. Readers may need a membership with JVIB or AERBVI to access that article. 

The information we gathered about the biological responses to touch included studies that used functional Magnetic Resonance Imaging (fMRI) and observations of behavioral responses to understand how the brain processes tactile information. Participants in the studies we found were generally sighted adults, not people who are blind, deafblind, have low vision, or individuals with complex access needs. The information we found is applicable to the human integumentary system (the skin), and these ideas should be considered beyond our specialty. However, the research that we uncovered can provide a scientific and research-based approach to the use of touch in the instruction of blind, low vision and deafblind learners. 

Though there are differing responses to human touch, especially for those who have experienced disorganized attachment or trauma, people for whom touch is a primary sensory learning channel are a subset of the general human population and are not seen as inherently different, either biologically or psychologically, from those who rely more on visual information. In addition, some areas of the brain of a blind person may be hyperconnected, as Dr. Lotfi Merabet (2023) explains. 

Neurological Responses to Touch

Discriminative and Affective Touch

The tactile system is divided into roughly two categories for gleaning information; the discriminative system and the affective system. According to the research, the discriminative system connects mainly to the cerebral cortex, where tasks like categorization and organization of information are processed. The discriminative system includes the glabrous, or non-hairy skin, such as the fronts of the hands, the mouth, and the bottoms of the feet. The discriminative touch system can be seen as investigative because it provides more detailed information about the tactile environment which is processed in the areas of the brain dedicated to problem solving.  

Information from the affective touch system, or hairy skin like the backs of the hands, arms, face, etc., travels mostly to the “lower” regions of the brain, including the midbrain and brainstem. These areas process social and survival information, which is closely linked in humans to the fight, flight or freeze response. The affective touch system can be seen as protective because it provides more general information about the safety of the tactile environment to the areas of the brain that are responsible for keeping people away from harm. One of the ways the affective touch system keeps people safe is to override the discriminative touch system when it is activated so that they can focus on the more urgent task of escaping danger rather than more complex issues such as identifying an object by its texture.  

Social and Non-Social Touch

The affective touch system can also be a way to convey emotional information to others. For example, a 2009 study showed that a variety of emotions can be communicated through a brief touch on an unseen stranger’s arm (Hertenstein et al., 2009). We also found a study from 2017 in which researchers found that most individuals reported increased feelings of well-being in response to a “soothing touch”, which consisted of using slow strokes on the arm with a natural brush (von Mohr, et al., 2017). However, we also found evidence that not everyone responds to touch in the same way. A study conducted in 2020 presented this “soothing touch” to individuals who had traumatic parental bonds and “disorganized attachment” patterns. These participants experienced the sensations generally associated with “soothing touch” as unpleasant, while those with “organized attachment”, or healthy parental bonds, experienced “soothing touch” as pleasant (Spitoni, et al., 2020).  

Another study found that while the part of the brain that evaluates our well-being and safety is activated by the affective system during social touch, this same area of the brain becomes inactive when a person is engaged in self, or non-social touch (Boehme, et al., 2019). This may indicate that the affective touch system is designed to be more attuned to the touch of another person. 

Active and Passive Touch

We also looked at studies that explored how individuals tend to respond to active and passive touch. These studies generally defined active touch as an individual acting upon an object or person, and passive touch as an individual being acted upon by an object or person through the sense of touch. Studies indicate that while passive touch may be more beneficial for rote learning, active touch is required for building sensorimotor skills and enhances the ability of the brain to build memory, making it the preferred mode for learning more complex problem-solving and critical thinking skills.

Social Responses to Touch

Controlling Touch vs. Non-Controlling Touch 

It is unsurprising that there is a lack of data describing the perspective of those who are the recipients of controlling touch. Many of these people have complex access needs and have not had the opportunity to develop the communication skills to express how it feels to have their movements and access to tactile information controlled. Studies by Rowland & Schweigert (1992, 2001) were able to analyze the effect that controlling touch had on the educators involved in these interactions. They noted that the educators became overprotective, which resulted in fewer opportunities for children to independently access an environment that had already been largely unavailable to them due to sensory and/or motor impairments. Conversely, a case study that included an observation of the non-controlling, cooperative exchanges of touch between a blind teacher and a blind pupil was described as an equitable dance (Anderson & Vik, 2001). This type of interactive, non-controlling form of touch, in which complex information is conveyed between two or more people almost exclusively through the tactile receptors of the skin, is also described in studies exploring the ProTactile language and culture of the DeafBlind community (Edwards, 2014, 2015). Controlling touch may also send social messages to the individual and to onlookers that the person whose body is being manipulated is incapable or untrustworthy, decreasing their self-esteem and also diminishing them in the esteem of others, which is known as “stereotype threat.” This can lead to poor academic and vocational performance and isolation (Silverman & Cohen, 2014). 

Implications

The data that was collected through this literature review is by no means exhaustive, and we hope that more research into this important topic will follow. So far, we are finding that neurological and sociological research supports what children have been telling us for years in both direct and subtle ways: non-controlling touch promotes independence and learning.  

Anecdotal and experiential knowledge of students and teachers has been strengthened by a systematic study of what the scientific community has found regarding the tactile sense thus far. Practicing research-based tactile teaching techniques can lead the practitioner to gain a more skillful use of touch that promotes social, cognitive and academic development. Integrating this thoughtful, brain-based approach into all interactions and instruction can increase positive outcomes for students, empowering them toward reaching their full potential in seeking information, problem-solving, and connecting with their community.

Using hand-under-hand to help a student explore a hedgehog at White Cane Day 2023

References

Anderson, K. J., Brandsborg, K., & Vik, A.K., (2001).  Hand over hand. A blind teacher of the visually impaired at work with a blind child. The British Journal of Visual Impairment. 19(3), 98-105.

Boehme, R., Hauser, S., Gerling, G. J., Heilig, M., & Olausson, H. (2019). Distinction of self-produced touch and social touch at cortical and spinal cord levels. Proceedings of the National Academy of Sciences, 116(6), 2290-2299.

Edwards, T. (2014). Language Emergence in the Seattle DeafBlind Community. ProQuest Dissertations Publishing.

Edwards, T. (2015). Bridging the gap between DeafBlind minds: interactional and social foundations of intention attribution in the Seattle DeafBlind community.  Frontiers in Psychology, 6; 1497, 1-13.

Hertenstein, M. J., Holmes, R., McCullough, M., & Keltner, D. (2009). The communication of emotion via touch. Emotion, 9(4), 566-573.

Merabet, L. B., & Ravenscroft, J. (2023). An evolving explanatory framework for understanding the complex profile of cerebral visual impairment. British Journal of Visual Impairment, 41(2), 197-199. https://doi.org/10.1177/02646196231163652 (Original work published 2023).

Rowland, C., & Schweigert, P. (2001). Assessment and instruction of hands-on problem-solving and object interaction skills in children who are deafblind. The British Journal of Visual Impairment, 19(2), 57–68. https://doi.org/10.1177/026461960101900203 

Spitoni, G. F., Zingaretti, P., Giovanardi, G., Antonucci, G., Galati, G., Lingiardi, V., Cruciani, G.,Titone, G., & Boccia, M. (2020). Disorganized Attachment Pattern Affects the Perception of Affective Touch. Scientific Reports 10.1: 9658. Web.

Schweigert, P. & Rowland, C. (1992) “Early communication and microtechnology: Instructional sequence and case studies of children with severe multiple disabilities”. Augmentative and Alternative Communication, 8, (4), 273-286.

Silverman, A. M., & Cohen, G. L. (2014). Stereotypes as Stumbling-Blocks: How Coping With Stereotype Threat Affects Life Outcomes for People With Physical Disabilities. Personality and Social Psychology Bulletin, 40(10), 1330-1340. https://doi.org/10.1177/0146167214542800 (Original work published 2014).

von Mohr, Kirsch, L. P., & Fotopoulou, A. (2017). The soothing function of touch: affective touch reduces feelings of social exclusion. Scientific Reports, 7(1), 13516–13519.